Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: detox (page 1 of 3)

Suboxone Detox Redux.

Four years after posting this interview with Dr. Steven Scanlan of Palm Beach Outpatient Detox, I’m still getting mail about how to tolerate Suboxone withdrawal. This piece and a couple others I’ve written rank in the top 10 in Google searches, and over the years I’ve been so deluged with comments and private emails about people’s struggles to get free of this drug that I keep a huge separate file for them all. I’ve talked or exchanged emails with some of these folks, and eventually I plan to put out a booklet that collects people’s experiences with this drug that is—depending on where you live—variously doled out like candy by doctors who don’t understand its strength, or available only if you drive two hours or three hours through the wilderness and pay cash to doctors who run their Suboxone clinics like whorehouses.

A reader named Bob wrote this morning:

I was using 16mg a day for 2 1/2 years, I was in excellent physical shape, ran 4 times a week, multiple half marathons, but felt enslaved to this drug. I went to an out-patient 6 week detox program, just in one week I went from 16 to 8 a day, next week went down to 4 a day, then the following week I went down to 2mg a day for a week before I “jumped”, I stayed off of it for 2 days, had ungodly withdrawals, so they gave me 2mg for one more day, I then went 9 straight days with nothing before I did 4mg on a relapse, now I am at day 6 with nothing. I am a business owner and cannot afford to be ” on my game”…any ideas as to when it gets to be ” manageable?”

I think Bob meant he couldn’t afford to be OFF his game. It seems like, in his detox center, they wouldn’t let him taper down to the minuscule doses that are most helpful in Suboxone detox. Many, many practitioners prescribing this drug do not understand its pharmacokinetics—how it behaves in the body, and how the body processes and neutralizes it. They think 2mg is a small amount.

 

A Suboxone film, cut for tapering.

A Suboxone film, cut for tapering.

Look at this picture. This is how some people taper off Suboxone. They cut the dissolvable films into little bitty pieces. The company that makes Suboxone does not advise doing this, because they say they can’t guarantee the drug is evenly distributed throughout the film, but guess what?—I think it’s because they don’t want people to taper off it. I’ve talked to Tim Baxter, M.D., global medical director of Reckitt Benckiser, manufacturer of Suboxone. In two separate interviews he told me, “We don’t promote detox.” They want you to stay on this drug. But you don’t have to.

Disclaimer: I’m not a physician, I’m just sharing experience and making space for many others to share theirs. If you want medical advice, you need to see a doctor. ... That said, Bob, 2mg is a significant amount of bupe to jump from. Like jumping from about 60 or 70mg of morphine (the gold standard drug to which all other opioids are compared in their analgesic and receptor-binding strength). I was tapering off the equivalent of 400-500mg morphine per day, and I used Suboxone for two months. I jumped off about 1/8 of a milligram—the tiniest bit in the photo above. Dr. Scanlan and other doctors who understand buprenorphine, the opioid drug in Suboxone, taper people down to fractions of a milligram before they jump.

So you’ve been six days clean after taking 4mg, and you continue to be physically active? Awesome job. Keep it up.

Some tips—take what you need and leave the rest:

  • Get good food. Eat no sugar, no caffeine, and as much organic protein (meat, fish) and vegetables and fruits as you can. Fuel your body well.
  • Get good sleep. Don’t take sleep aids, except for maybe benadryl or melatonin, which Dr. Scanlan prescribes during Suboxone detox (see above). A low dose of gabapentin helped settle my legs and get sleep. Hot baths also did the same thing—fill your tub with scalding water and enjoy feeling your muscles relax. Scanlan also prescribes Librium (chlorodiazepoxide)—if you can get a provider to help you for a month or so by prescribing a low dose of this, it may help you sleep.
  • Keep exercising. This will ease your restless legs and arms, reset your opioid receptors, and increase your energy levels and your appetite for good food. Yoga is also effective to stretch and relax the muscles that feel cramped and jumpy.
  • Meditate. Research shows that for recovering addicts, meditation restores the connection between the limbic brain (the part where cravings live) and the prefrontal cortex (the part that lets us make good decisions). In detox and post-acute withdrawal, meditation calmed my mind and helped me understand that every goddam moment of detox passes and that I could make good choices to foster my health.
  • Read Dr. Scanlan’s paper about Suboxone detox. Pay special attention to the section called “The Jump,” in which he says he tapers people down to very low amounts and advises his patients to stop the drug when they have a week or two to take it easy on themselves.
  • Find a supportive community. Anyone who has been taking Suboxone is struggling with an addiction. And nobody gets sober alone. We all have to learn to ask for help. When I was detoxing, I needed to be in touch with people every day. I did this partly on the public forum Opiate Detox Recovery (which has a special Suboxone forum), and partly in a 12-step program, where I got a sponsor who I called almost every day, and where I went to meetings where I met people who had done what I was trying to do and were holding down jobs, raising kids, and most of all being happy.

Even more information about how to take care of yourself while detoxing and dealing with post-acute withdrawal is included in my book, The Recovering Body, which you can get on Amazon and in your local independent bookstore. 

Edit: Here is an email from a guy called Larry that came in several days after Bob’s:

I’m a 60 yr old male engaged in hiking, climbing and biking.  I’ve had a 15 year long opiate addiction.  I’ve used suboxone for 2 years.  I started at 4mg.  I requested the low dose as I felt 8mg/16mg was more than I needed.  I reduced my dosage from 4mg to 1 mg over 4 months,  from 1mg to .25mg over another 4 months.  I jumped off from .25mg  ( 1/8 of a 2mg strip).  I had moderate WDs for a week, 3 weeks of significant lethargy and continuing mild lethargy.  I’ve been clean for 2 months.   I can feel it getting better and I’m staying the course.  I really don’t have any choice.  The alternatives are all non starters for me.

If you don’t make it this time, taper to a lower dose, no more than .25 mg.  It’s worth doing.

(Emphasis mine. 🙂 ) Fifteen years on opioids, and he’s now free. Congratulations, Larry.

Good luck to Bob, Larry, and the countless people out there who are trying to get free. Let us know how it goes.

Recovering Body_small

Dear G: Am I An Addict?

So I’m responding to two emails I received in the past week: one from a stranger, and one from a friend.

This is gonna be a long post, so get your iced coffee and your orange-chocolate-chip biscotto (my favorite) and sit down.

The Stranger has been prescribed Percocet (oxycodone), OxyContin (also oxycodone), and the antidepressant Cymbalta (duloxetine) for the past six years.

The Friend has been taking a teensy dose of Klonopin, a benzodiazepine—an addictive class of drugs used as sedatives and muscle relaxants—for the past year.

Both of them asked me for advice.

(Before I go on, I have to remind y’all that I’m not a doctor. I just share experience here—please take what you need and leave the rest.)

The Stranger seems more confused than the friend. The Friend, who has seen his share of addicted folks but is not in any program of recovery and never before thought he was addicted to anything, reached out to me because he knows I write about addiction. And he knows I don’t bullshit.

The Stranger writes:

I think I’m an addict? Am I? Am I not? Why is it even important to know if I am or not? Well, to me it’s important because I am having a HECK of a time coming off these meds.

This person has been tapering off 60mg OxyContin plus 40mg Percocet—a total of 100mg oxycodone, which truthfully is not that big a habit. It’s not a tiny habit, a tiny habit is two or three Percocet (15mg) per day, but getting off 100mg oxycodone is eminently doable, even if you’ve been taking Oxy for six years.

So let me tell you about some of the things I’ve learned about how to tell whether you’re an addict.

Obsession

It doesn’t matter how much we use, or how we use, or when we use (only after noon, only after 5 p.m., only after work, only after we put the kids to bed, etc.). It matters what the drug-use does to our minds.

Quitting 15mg versus quitting 100mg is like the difference between somebody who drinks two glasses of wine every evening and someone who drinks a bottle. Is the person who drinks just two glasses—but who cannot do without those two—NOT an alcoholic because she only drinks two? No. It’s what the two does to her. It’s how she thinks of those two glasses when she’s not drinking them, as well as when she is.

(BTW heavy drinking, for women, is usually defined as more than one drink per day every day.)

Both these people can quit their habits. The person who drinks only two glasses might have a harder time quitting because she thinks, “I’m only drinking two.” Or the person who drinks a bottle might have a harder time because her body has become more physically dependent and she’ll get sicker when she quits.

If they both stick it out, they’ll start to see benefits. It takes time. It takes a lot of days of sheer commitment not to pick up, and that itself takes a lot of support. For which I’d say, yeah, try a 12-step program, but give it a real shot: get a sponsor, take the steps, do what you’re told. If you’re really powerless over your drugs, wave the white flag (Step 1). If that doesn’t work, there are other ways of getting sober, but I know best what has worked for me and that’s what I talk about here.

Getting Our Drugs

Alcoholics can just go to the store and buy their drugs. We drug-addicts usually have to lie and cheat to get ours. Alcoholics wind up doing weird stuff AFTER they’ve bought and taken their drugs. For example, how do you hide all those empties—they clink when you try to drag them to the curb or the recycling bin, etc. … Drug-addicts usually aren’t faced with these kinds of questions (unless you’re shooting, which leaves tracks that you have to hide). Our questions are more about how to get the drugs in the first place.

If we’re using illegal shit, we have to commit felonies to buy it.

If we’re using legal shit, we also usually have to commit felonies to buy it.

I committed I don’t know how many felonies to get my drugs. A lot. More than 10. Enough, probably, to warrant a prison sentence, because I committed them over and over, over time. They all expired this summer, which made me feel free, in a sense, but in another sense I can never make up for having committed them in the first place. I talked to a lot of people about how to make amends for having committed felonies that put doctors and pharmacists and my own family in danger. They all said, Change your behavior and stop doing it. Tell other people not to do it. So:

Don’t. Change. Dates. On. Scripts. It’s fucking dangerous and can hurt more people than yourself.

The Stranger is not yet committing felonies. But she’s doctor-shopping. She’s been to four doctors other than her regular doctor to get drugs to supplement her regular scripts. More and more states are enacting doctor-shopping laws.

//

The green Watson-387 hydrocodone tabs I used to chew when I was becoming an addict. Bitterness on the tongue.

The green Watson-387 hydrocodone tabs I used to chew when I was becoming an addict. Bitterness on the tongue.

Let me tell you a story. When I started using legal drugs, I didn’t think I was an addict and I thought the amount of drugs I was being prescribed (45mg hydrocodone per day?—or something like) would last me frigging forever. I had spent the past two or three years trying to make thirty 10mg Watson-387 hydrocodone tablets last an entire month, and I’d always run out, because, of course, I Was In Pain, and the pain needed to be treated. When I scored ninety 15mg caps per month, I saw a road paved with those white-caps stretching to the horizon and thought life was finally perfect and I would be taken care of forever.

What happened was, in two months I needed 60mg per day.

By the end of that year I was being prescribed 150mg per day—ten 15mg caps. I would get a delivery of 300 15mg capsules each month. A delivery. The Man would come and deliver them. Personally, I think this qualifies as an official “shitload” of drugs, but just wait:

By the end of the next year another 120mg morphine (in the form of Kadian, a long-acting capsule) had been added to that, and in another six months I was given extra fentanyl lollipops. Pharmaceutical Tootsie-Pops. No: Dum-Dums, really. By that time I was a stone junkie, although I still had trouble believing I was, because I was still doing my life. Opioids don’t disable you the way alcohol and, say, meth do: I didn’t look drunk because I wasn’t drunk. I was just on a shitload of drugs, and when I ran out, I was incapacitated in every way.

And toward the end I always ran out.

Running Out

“When I would run out of the meds early,” The Stranger says.

People who don’t have problems taking their meds don’t run out. People who do have problems taking their drugs do run out.

“But I hate being high!!!”

“I LIKE feeling normal and sober!” she writes.

Oh, sweetheart, pleeeze. I hated being “high” too. I just wanted to be normal. I just wanted to have energy when I wanted, be relaxed when I wanted, be accepted.

“I never drink (hate the stuff!) or smoke marijuana, and I’ve never done any hard drugs.”

Solidarity, sistah. <fistbump> I am a Top-Shelf White-Collar Addict all the way.

By the time I detoxed five years ago, I hadn’t seriously drunk alcohol in more than a decade. I “hated the stuff.” And I’ve never done any street drugs. Ever. Never smoked cigarettes, let alone weed. Never danced topless on any frat bars, never stripped for the dudes, never screwed around. I’ve never woken up in anyone’s bed I didn’t actually have a relationship with.

By the end I had a kid, for chrissake, and I Took Care Of Him, and I did a good job, not the best job I could have done, because I was a stone junkie.

If you like feeling sober, then quit sooner rather than later. You will only feel more and more sober. The feeling of extra energy I got from pills was fake energy. If you can exercise at all, your body will soon start producing its own endorphins and you’ll heal.

But you will not start to heal until you quit putting extra opioids into your body.

Anxiety and Fear

One of the most helpful things I’ve ever heard was from my first sponsor, who told me that I needed to call anxiety by its right name: fear. “Because anxiety can be medicated,” she said.

But you don’t go to the doctor and ask for pills because you’re having fear.

The Stranger mentions fear over and over again in her email. It’s a signal of addiction.

The Friend’s email had none of that fear. He was balls-out about his concern: “I believe I have become addicted.” Which is the thing that made me think he wasn’t addicted: we addicts tend to keep second-guessing ourselves. Even when we ask for help, it’s usually: “I think I MIGHT be addicted,” or, “Am I addicted?”

But who am I to know for sure? I don’t know how much fear or obsession he has or whether he’s running out of his tiny dose of Klonopin each month and changing dates on scripts to get more. (I’m pretty sure he’s not committing that felony; after speaking with him, I don’t think he’s even running out.)

This is one of the aspects of addiction that needs a lot more research. If we’re going to treat addiction as an illness, we need clear diagnostic criteria so that it’s not a matter of self-diagnosis or self-identification.

Pregnancy

I’m not a doctor, and I’m not an addictions specialist, but I’m a mom and a woman and I wrote a book on pregnancy for which I did more than a little research, and my mind is made up about this: if at all possible, unless the mother’s life is threatened (which is to say, unless she’s already on a load of heavy drugs and gets pregnant and can’t detox without endangering herself and the pregnancy), women ought to get off their drugs if they want to get pregnant.

There are a lot of studies starting to come out about the “benefits” of buprenorphine over methadone in pregnancy, but most of those are for heroin addicts and/or methadone-maintenance patients who are already pregnant.

The Stranger has tapered down to 30mg of oxycodone per day. I hope that, before she gets pregnant—which she says she wants to do—she’ll quit entirely.

Because motherhood is damned hard work. And it’s best to do it sober. It is the single thing I wish I could go back and change: I wish I’d been entirely sober for my kid’s childhood.

Please don’t miss your kid’s.

The boy, age 3.

The boy, age 3.

If this helped you, the best thing you can do is pass it on via the little social buttons below.

Also, please visit my new site: Recovering the Body.

To Use Suboxone, Or Not To Use Suboxone?

A reader writes:

Hi G,

I know there is no magic bullet or simple answer, but I thought you may have a suggestion for me. I’ve been taking perc or ox for five years, for the first 3 it was only 30-50mg/day but now it’s between 150 and 180.

Suboxone scares the shit out of me, but at the same time, every time I try to taper, I fail and I’m starting to go broke. I lost my health insurance.

I go to meetings 4 or 5 times a week, all helpful, but the physical part keeps me hooked.

I heard suboxone may be ok if used very briefly (like a month or less), as when taken for longer, the withdrawal is way worse than the oxy itself. I wish I could go to a 7-day detox or something, but I just don’t have the money and I don’t have insurance. I also freelance so I need to be able to work and I can’t lose more than a few days. 

Anyway, I started trying to find low-income or sliding scale suboxone programs in NYC, but it’s slow going and I don’t want to just get hooked on something else. I have read long term effects of suboxone are bad too.

I guess my Qs are:

if I were to do suboxone briefly, a few weeks, would I just then have the same withdrawal as I would going cold-turkey from the oxy anyway?

is there something else in my area (or anywhere) where someone could go for opiate detox that costs nothing or very little?

I want to be clean so bad, but every time I try to taper I just fail.

Any thoughts/suggestions appreciated – I know you’re not a doctor or professional, you just seem to have a lot of info and I know how we like to help each other. 

Thanks in advance.

B

Dear B,

There is no magic bullet, but in my experience there are simple answers.

The first was to know that I wanted to get clean. (Which you say you do.) First problem solved: I was telling myself the truth. The truth was, I was willing to do what it takes. And It Takes What It Takes.

The second was to ask for help. (Which you have. Keep doing it.) Nobody, but nobody, does this on his own. Even the people I know who don’t go to meetings have put together communities of other people trying to stay sober.

The third was to use my willingness and my growing community to decide on a path, and walk the walk.

For some people, Suboxone is the solution. They’ll tell you they don’t mind eating an opioid for the rest of their lives—it’s “like a diabetic taking insulin.”

In my opinion the diabetes analogy is worn out. I wanted my solution to be real freedom. When I reached out for help I met people who had shot heroin and who had gone bankrupt buying drugs over the Internet and who had drunk themselves into blackouts—people who drank and used to the excess I had, or worse—who were clean and sober. I wanted to break ties with all drugs that cause physical and psychological dependence. For me taking drugs is signing on for slavery. Just my reality.

I really wanted to go to rehab but I knew I couldn’t leave my kid for that long.

Here’s how I decided on a Suboxone taper.

I knew I couldn’t detox off full-agonists like oxy. Too alluring. (More truth-telling.) I needed to change all my habits. So I asked for help—I found a detox doctor who was willing to oversee a Suboxone taper for me.

I told him at the outset that I wanted to taper. When my resolve flagged, he reminded me that the project was to get free.

I put the taper in his control. I never had more than one week’s worth of drugs in my possession. He wrote out the taper, I wrote out the check, we shook hands. I waved the white flag and gave up.

I did what he and a bunch of other people—Dani, Allgood, Sluggo, Bonita, all online friends; and my new real-life sponsor and community—told me to do. I put my faith in the people who were sober and who told me I could be, too. I burned a script for more drugs. I went to meetings and opened my mouth and let myself cry on people. I kept collecting sober people around me.

Several weeks later I was drug-free for the first time in years.

And yeah, I ain’t a doctor, but I’ll offer this anecdotal caveat: if you’re taking 180mg Oxy, they’ll try to start you out at 8-12mg Suboxone (or maybe even more). But that would be increasing your tolerance. If you really want to get clean, you’ll start at 4mg and taper to 3mg within two days. You could do a 2-week taper, cutting to 1/4mg—the equivalent of 1 Percocet—at the end and have a relatively smooth landing.

Post-acute withdrawal.

I ain’t gonna kid you: staying clean was a slog. Tapering off suboxone was not nearly as bad as detoxing cold-turkey from fentanyl or oxy, but it wasn’t painless—I shivered, I kicked in my sleep, I sneezed 20 times in a row. Keep in mind, my tolerance was more than twice yours, and I’m probably a little smaller than you. I spent each day telling myself if I made it to bed without having stolen drugs (because yes: I used to steal drugs) or used anything, including alcohol, I was a success.

The best treatment for drug-cravings was vigorous exercise. It helps the body produce its private supply of morphine and dopamine. Dr. Steve Scanlan told me research shows people who exercise cut their recovery time in half. I made playlists that helped me drag my body around the neighborhood. Walk, run, cycle. Do pushups. Lift weights. Start small and grow bigger. I exercised, and my body and mind recovered.

Healthy. (Mostly.)

Healthy. (Mostly.)

A 180mg oxy habit is totally beatable. With a stick, my friend. Dude, if I can get clean, you can. I was on more than twice that and I’m free today. And I did not use insurance to get clean. But I paid what it took—the first of several critical investments I’ve made in myself over the past few years. Paying that doctor made me realize that, for a long time, maybe all my life, I’d withdrawn a great deal without putting very much back.

 

The most important information here: Get to a meeting. Tell them you want to get clean. Ask them to help you.

If you feel you need inpatient or other professional help, try Phoenix House, a large NYC-based treatment system with detox facilities in Long Island City. Or try the “free and affordable” resources listed on this website.

Don’t Hold My Sobriety Against Me.

Dr. Abraham Twerski, about 10 years ago. Photo via Post-Gazette / Bob Donaldson.

This is what Dr. Abraham Twerski said yesterday at a talk to some of the people who have been helped by Gateway Rehabilitation Centers, the rehab he founded. 

I’ve been hearing about Abe Twerski since I came back here to go to grad school in 1988. A good friend at the time was doing a long-form nonfiction story on the Hasidic Jewish community here, and I remember her mentioning his name.

The first thing I noticed: Abe Twerski’s voice sounded different than I expected it to sound. I expected low-pitched, hoarse, somber. He’s been a rabbi since the 1950s. I heard a tenor voice, clear, energetic, engaged, humorous. I knew he was in his 80s, but he didn’t seem in the least frail. He was dressed in the orthodox manner: long gray coat, black trousers, black velvet yarmulke, and a long white beard that grew into two points.

(“That’s so cool,” my 14-year-old skinny-jeans-clad son said when I told him about it last night at dinner.)

Twerski said he has been going to AA meetings since 1960. “I haven’t been drunk, and I haven’t used drugs, but I go to meetings regularly,” he said. “I tell people, ‘Don’t hold my sobriety against me.’ I need these meetings as much as any of you do.”

We weren’t at a meeting. It wasn’t a couple dozen folks in a church basement. He was standing in front of more than 500 people. The room was silent. Twerski was obviously comfortable with this scene. At the same time, he was spontaneous and fresh, telling 50-year-old stories as if they had just come to his mind for the first time. The middle-aged call-girl-turned-street-hooker and low-bottom drunk, who had detoxed 69 times at his hospital, 23 times at St. John’s, and god only knew how many times at Allegheny General and McKeesport—he couldn’t get the records from those places. So she’d detoxed more than 100 times—medically detoxed. Who knew how many times she’d tried to quit on her own? 

I thought of people I’ve known who have despaired of getting sober, who have quit maybe eight or 10 times. I thought of myself, detoxed just three years ago, outpatient, with the help of a doctor referred to me by Gateway’s people. (When I needed an outpatient detox doctor, I called the best in the city. I called Gateway. When my PCP recommended the same doctor, I knew I had the guy who would help me.) I thought of my parents, who tried many times to quit times and never could.

The big dude sitting next to me, 50-something guy with tattoos and tight faded jeans, wiped his eyes now and then. I thought he had something stuck in one of them, but no.

I was sitting at a table right next to Twerski’s. After the talk I shook his hand and asked if I could speak with him sometime. He smiled and waved at the mob crowding around him. “Yeah, give your number to my people out there,” he said and trudged through the crowd.

So I’ll be running an interview at some point with this very cool physician and rabbi who knows how to talk about God without freaking people out. I have questions lined up. Anything you want me to ask him, let me know.

Withdrawal, One Day At A Time.

Went to a meeting yesterday. Topic: “One Day At A Time as a spiritual practice.”

Today is the third anniversary of the day I jumped off my medical detox. My detox doctor prescribed Suboxone to help me land my plane off a 30,000-foot level of Fentanyl. I spent two months on Suboxone—almost triple the time this doctor usually allows his patients to spend on that drug. He was very kind to me and one of my first acts of “recovery” was to repay his kindness by taking the drug responsibly—by showing him that I actually wanted to detox.

If you find it difficult to manage withdrawal by yourself, it might be good to find a doctor you can trust to help. The only way I managed detox was to turn the process over to someone else.

A lot of people come to Suboxone-detox doctors with heroin or Vicodin or OxyContin problems. Their supplies of pharma drugs have been erratic, and the quality of heroin is uncertain. They run out of money or their dealers run out of dope. So some people haven’t been on a steady level. Detox is somewhat easier if you haven’t been on a steady level: in the down-times, the body has a chance to regain some equilibrium, and there’s not so much physical damage to repair.

But I was on a fairly steady level, and the level was towering, the equivalent of 400-600mg of morphine per day. Crazy-high level.

I never thought I’d ever, ever—ever—be able to jump and land on the ground with both my legs intact. I’d tried. I’d gone into withdrawal (voluntarily, involuntarily) over the years, and gotten partway, only to be driven back to the drugstore to get the thing that would relieve the suffering of severe withdrawal.

In withdrawal from any drug on which the body becomes dependent (including psych-meds), the body and mind experience problems operating optimally. For opioids the physical problems include sweating, cramping, vomiting, goose-flesh, headaches, soaring blood pressure, insomnia, extreme deathly fatigue. It’s often the last two, which can hang on for ages and which affect psychological wellbeing, that drive people back to drugs.

Alcoholics go through sweating, racing heart, weakness, palpitations, tremors, seizures. The seizures can be life-threatening, which is why it’s sometimes better to do a medical detox from alcohol-addiction.

Mel Bochner, "Blah, Blah, Blah," 2009. Saw this at the Met last week and it reminded me of my kid's art.

And then there are the psychological disturbances. Confusion. “Anxiety” (otherwise known as fear). “Restlessness, irritability, discontentment,” blah blah blah.

In opioid withdrawal there can even be a kind of euphoria as the body begins to return to normal functioning. The senses come alive; food tastes good again; we walk into the kitchen and our mouths water; appetites return. There have been documented cases of spontaneous orgasm in opioid withdrawal. The body, no longer drugged and dulled, begins to produce the hormones that support normal sexuality—and the physical and emotional responses go a bit overboard for a while.

//

People in yesterday’s meeting were talking about One Day At A Time. I heard a saying that I’d heard long ago in a meeting: “You can start your day over at any time—even an hour before bedtime, you can start your day over.” I was reminded of how my friend and mentor Sluggo used to ask me, after I jumped and was feeling lousy and was facing a Thanksgiving holiday with family in the house—exhausted from detox, unable to look at cleaning the entire garret guest-space; upset, as always, at the grunge on the kitchen floor—Sluggo used to ask me,

How are you now?

And now?

And now?

I didn’t get this at the time. “I’m FUCKED UP NOW!!” I’d scream at  her in my head.

I could have screamed it at Sluggo in real life (“IRL”) and she would have sat there, like, OK, so you’re fucked up now. She never tried to force solutions. She rocks at detachment.

Sluggo is wise, and streetwise; she’s quite literally been around the world, and she’s seen and done a lot of shit. She’s lived in Tokyo and Paris and other places where supermodels live while they’re showing haute couture. She’s been held up at knifepoint in Chicago, trying to cop, shivering from withdrawal and exposure in an evening gown that she was supposed to be modeling. … After a lot of tries, she got “clean.” She got married, had a kid and now uses the 12 steps to stay sober and sane.

(I love her.)

Step 11 is Very Important to Sluggo. She knows how to meditate. Because she meditates.

Her question (“How are you now? And now?”) is about meditation. Meditation is about practice. The practice of meditation changes the body and nervous system. It counters paranoia, compulsiveness, anxiety, “restlessness, irritability, discontentment.” For people like us, it’s medicine.

After Sluggo asked me this question a few times, I began to realize that Right Now I was safe and well. “FUCKED UP!!” is a mean judgment that hides great expectations. “Safe” and “well” are facts.

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At the meeting yesterday I was sitting next to a woman who said she had 40 days. From the sheepish look of her, she felt kind of bad admitting she had “only” 40 days. Murmurs around the room: “Awesome!” “Forty days rocks.” “Forty days is HUGE.” There was a guy there who had five days. Then people started talking about how we only have This Day, and how This Day can start over again at any time, so really we only have This Moment.

How are you now?

And now?

And now?

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