Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: sober (page 1 of 4)

Valentine’s Day: #Sobersex Vid Series!

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Since publishing Sex in Recovery, I’ve discovered that so many sober folks want to talk about sex, but they’re scared to start because they don’t know how. We’re raised not to think about sex, much less even talk about it, and to hide our experiments in this rich, healthy world of desire and pleasure. The culture bequeaths us the crazy-ass paradox that sex is dirty and that we should save it for the one we love.

I’ve talked with dozens of sober people about sex, and Lara (pictured above) is enthusiastic, sensible, and fun! My new #sobersex video series goes live on Valentine’s Day—the day I think we should love ourselves first, give ourselves not just chocolate but also self-acceptance and commitment to discover who we are.

Secret Facebook group for women: And if you want to be part of my new secret FB group for women interested in discussing sobersex, follow my Facebook author page and shoot me a DM.

I Am Not “Clean.” You Are Not “Dirty.”

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On the screen—some of the ways we can use language to reconceive of what we’re doing in fighting addiction. With Michael Genovese, MD, JD, addictions psychiatrist, integrative healer, and CMO of Sierra Tucson.

I’ve been saying for years that language matters. I’ll line up some of these posts for you:

  • here, a post about my spiritual soul-brah Dr. David Servan-Schreiber, who wrote books teaching people how to look for the innate healing power (HP) inside themselves
  • here, about Christopher Hitchens’s death—”Poor Hitch,” who used language to deceive himself and others about his addiction-driven illnesses that killed him
  • here, after a NYC AlAnon meeting—the first time I wrote about sober sex (very cool ending!!)
  • here, about my discovery that most people in recovery do not have language to express the unspeakable sexual transgressions many of us endured in childhood. This also denies them access to language for the joy they experience, or imagine, in adulthood

There are many more. Go search “language” on Guinevere Gets Sober.

MA-Language-Cognition

I’ve been writing about language’s bearing on addiction and recovery for five years. Now, thank goodness,  people (especially the youngsters, like Holly and Laura) are finally paying attention to language and its implications for recovery success. I went to amazing meetings in NYC last week in which a clinician said, “We don’t call urine testing ‘dirty’ or ‘clean,” we call it ‘positive’ or ‘negative’ for presence of opioids.” Sigh. About time.

I have never called myself “clean.”

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Michael Botticelli, the new director for the federal Office of National Drug Control Policy, has said he is not an “addict” or “alcoholic” but “a person in long-term recovery.”

Yet!!!

I can hear old-timers say, “Yet.” The “yets” are the things that haven’t yet happened. “He shouldn’t be up there saying he’s in recovery because what if he relapses?” Michael Botticelli could drive his beemer or whatever to suburban Virginia and ask a bartender to line up some shots, or he could cop some heroin, where east of DC it’s said to be 65 percent pure (if it’s not spiked with fentanyl). He could crash his car.

But the fact is that by articulating that he is “a person in long-term recovery,” or when I say in a meeting, he is living in the present moment, and he gives hope for other people.

In meetings I now say, “I am sober and awake today,” and that declares what I am—what I want to be, what I’m working toward. Hell, it gives myself hope.

“I’m Joe and I’m a miserable lying cheating powerless alcoholic”

That ritual was born of early rehab culture, I was told, when residents (mostly men) were told they had to submit to “ego-deflation” (or “ego-puncturing” as it’s sometimes called in The Literature).

This term—”ego-puncturing”—came up in a women’s meeting yesterday. We were passing around the 12-and-12 and reading Chapter 7 together. Chapter 7 is awesome in that it promises—PROMISES, a big word in traditional recovery—that we will be able to use not only the strengths we’ve started to gain but also all our stumbles and past fuck-ups (with which we identify much more strongly) to actually help people.

The fuck-ups, in particular, are our key to recovery. I mentioned in that meeting (or Saturday’s, I can’t remember) that I had been arrested and stuck in jail with a pocket full of fentanyl that the cops never found. This story is always helpful for newcomers because they look at me, all put-together with mascara and shit, and talking calmly about jail, and it proves we may have some things in common.

What seem like sexual fuck-ups in particular can help other people, and ourselves, if only we can find the language for them.

Example:

One 40-something guy named Tom told me he’d started having sex with a woman whose grass he cut when he was 16. It sounds like something out of a Stephen King novel, right? And it was basically statutory rape. Because 30-something women are not supposed to fool around with 16-year-old boys. He was sixteen, right?

When I would have sex with someone all I cared about was making sure they had pleasure, because I wasn’t sure I could get pleasure from it, because I was too scared.

BOOM: into language, the feeling most 16-year-olds (and 40-year-olds, and 50-year-olds) are afraid to say.

Then he started rolling his mower over to her house. Drinking some lemonade in the kitchen led to her taking him to her bedroom.

She showed me how to please a woman. She showed me ways to manipulate her body, mostly with my hands, and taught me about breathing exercises to take your partner through so you could mutually breathe together. At certain points she would take my hand and place it on her solar plexus and she would reach out and touch mine when she was close to orgasm. She taught me certain areas within the vagina, about the nervous system—I mean, she was very extensive in her education. It was weird, but it was also kind of cool, because she was showing me things with which I literally had instantaneous results in my later life.

Educating Tom.

I laughed at this story. Tom looked at me askance. I said, “It’s not a prurient laugh at all.” He recognizes this because clearly he understands that an irony stands as one of the pillars of our recovery: within the strange, fucked-up illegal shit that happens to us and that we cause to happen to others are the nuggets of gold that we later mine and hammer into gifts for ourselves and for others.

If we can put language to it. It’s little good to us or to others without language. But language and labels are not the same. We need to ditch the labels.

 

with thanks to DM for the video.

We Feel Fine.

Waiting for the CDC to get back to me about the study released yesterday about the social costs of alcohol abuse. My Dutch friend P spotted it too. The link she sent me was in Dutch, and so was the headline:

“Bijna 80.000 alcoholdoden in VS per jaar”

That means “Almost 80,000 dead from alcohol in U.S. per year.” Another holy-shit fact buried in the study: an estimated 550,761,000 (550.7 MILLION) gallons of ethanol in the form of 7.5 BILLION total gallons of beer, wine, and hard booze were consumed in the U.S. in 2006.

While waiting for sources, made this discovery: awesome website about feelings.

Via a link from the Nieman Journalism Lab at Harvard, whose project is “trying to figure out the future of news.”

Follow @NiemanLab 

(Follow @Guinevere)

We Feel Fine: photos and blog-quotations from people all over the world, expressing real feelings in real time.

Made me want to listen to this song. Hadn’t remembered Glenn Frey was so hot.

(Scorpio like me. And my husband. And my cousin Danny, who looked just like Glenn Frey and who helped me get sober. More about Danny later.)

Searched “We Feel Fine” for the feeling “sober.” Check it out. To make your day, some screencaps:

We Feel Fine

We Feel Fine

We Feel Fine

Sober Life: Being A Sober Mom

Said goodbye this morning to my 13-year-old, watching him shamble down the front steps into the first mild morning we’ve had this year. There was something about how he looked walking toward the school bus, wearing the new coat that he calls his “rock-star coat,” which he bought on his own when he walked with his friends from our house down to the shops last week… I watched him from behind, and coupled with that feeling that he’s no longer my little boy came a regret that I’d spent a number of years of his early childhood unsober.

I shut the door, locked it, walked back into the kitchen and started washing the dishes from breakfast before settling down to work. Pretty soon my tears were dripping into the dishwater. Sometimes I can’t do anything about it: I Regret The Past and Wish To Shut The Door On It.

Thirteen years ago, I was a fearful new mom. The fear settled on me as soon as I knew I was pregnant. I knew I was pregnant even before I took the drugstore test. I could feel it in my body. I’d gotten pregnant by accident and after the second line in the pregnancy test’s window confirmed what I already knew, I stood in the front hall and burst into tears—I was sure I had no idea how to raise a kid, and I had no confidence that I could figure it out. I read lots of books, and I even wrote a book about my pregnancy (which was great—my pregnancy, that is), but books didn’t give me that sense of Being Right inside myself.

My son, at a couple weeks old. From my first book. (Photo by Charlee Brodsky.)

When my son was born, and I saw his face, I knew he was the one I was supposed to meet. You know what I mean? His eyes were open. They were stone-colored, and he looked hard at me. I was absolutely flattened by love. I swore to myself I’d do my best.

My best turned out to be several years of addiction.

I got sober when he was turning 11.

As I finished washing the dishes I thought to myself how I can’t turn the clock back. My kid is one person I have to make living amends to. You can’t go to a child and tell him the ways you’ve harmed him… The facts of parenthood force me to live as an example of sobriety, to live as healthily and as spiritually-directed as I can today. Letting the rest go is the hard part. The self-recrimination. The thoughts, when I look into his face, of “what if?” What if he’d been given a different mother. What if I’d been able to get sober earlier. Blah blah blah, self-pity.

I know how I’m supposed to think. I’m supposed to stay in the present moment.

Doing the dishes and cleaning the kitchen always makes me think of my own mother. She taught me specific ways of house-cleaning. She did not tolerate drips or crumbs on the countertop. She did not tolerate leaving dishes in the sink. We didn’t have a dishwasher. She used to point to her piano (which is now in our front hall) and say, “There’s my dishwasher”—to emphasize the point that she’d chosen to invest in a musical instrument rather than a kitchen appliance.

I used to think at those moments that, actually, I was the dishwasher, and so was my sister, but I never said so.

We didn’t even have a sink-sprayer. There was a little cup by the faucet that we used to rinse out the sink. (Of course, we had no disposal.)

This morning as I wiped the countertop clean I thought of my mother. She’s been dead of lung cancer from smoking, it’s been almost 12 years.

Recently my father-in-law died, and my husband, on the first night after his dad’s death, curled up next to me in bed and asked, “Where do you think we go after we die?” It was a childlike question borne of childlike feelings. I thought of my mother then. There is nothing left of my mother’s body, surely, except her bones. Her grave is on a hillside 15 miles to the east of here. But can it be said that there is nothing left of her, when I so diligently empty the sink, when I wipe the countertop clean… when I beat myself over the head for making mistakes—the way she taught me?

Instead of doing my yoga at home today, I went to my friend Jenn’s class. I needed to get out of the house, and I needed to hear Jenn’s voice. As I walked in, she was already leading the students in opening meditation. I sat down on my mat, and Jenn said, “Now think of a place of comfort,” and the first thing that came to my mind was my  mother’s lap when I was a child. I could feel her shoulders under the blue-and-brown flannel shirt and I could smell her cigarette smoke, and I could hear her voice. Though my mother hit me when I was small, I also remember how much I used to love it when she sometimes held me on her lap. She also sometimes sang, or read books.

I held my son, I sang to him, I read to him… even when I was not sober…

I started to cry in the yoga studio. (I was in the back…)

One problem I’ve had is that I made my mother my higher power. I did everything she said, down to wiping the countertops clean in a certain way. I am a good reporter and student because I can remember conversations and lectures verbatim, because I was trained to remember things my mother said (or else).

I can see that my son won’t have some of these problems. I’m not his higher power. He is not my confidante. He has privacy, and a good relationship with his father, and productive friendships. There are appropriate boundaries between us.

Driving home from yoga I was thinking that, at the very least, I’m here. I’m alive and well, if not perfect. (By now you will have noticed that I’d like to be perfect… 🙂 ) I think kids are hardwired to forgive their parents, especially if their parents make an effort. If my mother had gotten well, and had lived to see my son grow up, I could have let go of everything that had gone before.

I mean, by the time she died, I had let go of it anyway. … Anyone know what I mean?

But who knows how much possibility for growth, how much joy we might have had?

And she would have been here. Priceless.

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

Suboxone: Amazing Detox Tool, Monster Maintenance Drug.

An Expert Talks About Suboxone: Dr. Steven Scanlan of Palm Beach Outpatient Detox

Steven Scanlan M.D.

Steven Scanlan M.D., medical director of Palm Beach Outpatient Detox

Steven Scanlan, M.D. is board-certified in psychiatry and addiction medicine. In his practice, Palm Beach Outpatient Detox (PBOD), on the Florida coast, he has detoxed more than a thousand patients off many drugs, including alcohol, benzodiazepines (Valium, Xanax, etc.), and sleep aids. But his specialty is opiate detox.

Scanlan has been practicing as medical director of PBOD for about two years. His practice, he said, is located in an area where more than two-thirds of all oxycodone prescriptions in the nation are issued—the south Florida coast that has become notorious for its “pill mills.”

Scanlan said 70 percent of his patients come to him addicted to oxycodone at levels of about 300 to 600mg per day. About 20 percent also come in with alcohol problems. “The rest use Vicodin and Ultram,” and a few come in addicted to Fentanyl, he said.

And then there are the increasing numbers who come to him desperate to get off Suboxonea drug that combines buprenorphine, a synthetic partial-agonist opioid, with another drug to prevent abuse. Suboxone (commonly known as “Sub” by people with addiction) is used in opiate detox and maintenance, it’s known and “prison-heroin,” and it’s now commonly sold on the street.

Scanlan says he has seen Suboxone work brilliantly as a detox tool and dangerously as a maintenance drug.

I first heard Scanlan speak on a podcast that’s now defunct. Two reasons I was eager to talk to him:

1. Scanlan chose addiction medicine as a result of his own recovery from opiate addiction. He understands addiction from personal and professional experience. While training to become an anesthesiologist Scanlan became addicted to Fentanyl, a strong opioid used in surgical procedures and for severe pain. After trying many times to quit on his own, he found a physician who helped him detox over two weeks using Subutex—plain buprenorphine—and other medications to ease the detox symptoms. He joined a recovery program, then decided he was well equipped to help others suffering from the same problem. Many of his physician colleagues didn’t like working with addicted patients, but he found he did. In his practice, he doesn’t just dole out drugs; he gives patients 24/7 followup until they’re physically comfortable and involved in some kind of support program.

2. I wanted to hear his clear-cut ideas about detoxing off opiates. He only does detox. He never does maintenance. Unlike so many other scientists, who believe people addicted to opioids can never stay off them, he believes we can get free.

“Believe me—it’s much more lucrative to do maintenance, to keep patients on Suboxone,” he said, adding that it’s even more profitable than, for example, doing Botox injections. Hundreds of practitioners—some of them with no experience with addiction—prescribe Suboxone as a maintenance drug, keeping patients on it for years at high levels and charging exorbitant cash fees. But for the vast majority of addicted people, Scanlan does not believe drug-maintenance is appropriate—or even safe. Buprenorphine is such a new drug, he says, and its long-term effects have not been adequately observed and researched.

He has said that Suboxone may curb cravings for other opiates and allow people to stop stealing and get their lives in order. But the problem is that, after three months or so, patients have terrible difficulties quitting Suboxone because of its sheer strength in binding to opiate receptors, its long half-life, and the fact that it’s a partial-agonist binding to receptors built for full agonists. And despite what the media tell us, there are many people who don’t want to spend a lifetime on high doses of Suboxone.

You know what? When I was detoxing off fentanyl in 2008, I felt so good on Suboxone that I thought about staying on it. Then something happened. I no longer felt so good. My feelings dulled. I no longer wanted food or sex. I realized my body was adapting to the drug—or trying to. Fortunately my outpatient detox doctor had no more slots for Suboxone maintenance patients, so I tapered off as quickly as I could. If my doctor had been operating under the new Comprehensive Addiction and Recovery Act, he may have had a slot for me, and I might have gotten trapped on Suboxone as so many others have.

Scanlan said most people, including physicians, do not comprehend the strength and effects of buprenorphine. “Everything changes in the body when you’re on opiates long-term—the way the body regulates pain, the way it regulates hormone production, sleep, emotions—everything,” he said. And buprenorphine, he repeats, is an opiate. Its effects are not just physical: as a psychiatrist, Scanlan has noticed in his practice that at long-term doses of just 2mg, Suboxone can block almost all of a person’s emotions.

In addition, buprenorphine’s half-life is 37 hours, which means it takes the body more than a day to excrete half the dose. When dosed once a day, the body doesn’t have time to catch up, so the drug builds up in the system—a phenomenon called “bioaccumulation” that Rachel Carson documented in the buildup of toxins among wildlife in her book Silent Spring. A patient dosing with buprenorphine at 8mg is not only getting 8mg—he’s getting the 8mg, plus the amount not yet metabolized from the day before (4mg). And 8mg is a low-end maintenance dose. In the U.S., patients are commonly dosed at 16mg or 24mg per day.

“There’s definitely a risk to going on Suboxone long-term—anything over three months,” he said. “It would be easier to detox patients if they were coming in at a year’s time at one milligram, or a half-milligram, which is where they should be. But they’re always coming in at 16 milligrams. Or 4 milligrams for four years but really they’ve been at 8 milligrams and they’ve lowered it just before they’ve come to see me. I have to get them to tell me what they’ve REALLY been taking.”

Scanlan is the only professional I’ve ever heard who can explain why the body reacts so differently to Suboxone than to full-agonist drugs like heroin, Vicodin and methadone. Read on…

Suboxone tablets

Suboxone 8mg tablets

G: Educate me about buprenorphine.

Scanlan: It’s the most amazing detox medication I’ve ever seen. But for maintenance—it’s harder to get off than methadone. Suboxone is 25-45 times as potent as morphine. It’s the king of the hill in terms of opiates—it displaces every other opiate off the receptors, except for Fentanyl. [Maintenance physicians] use way too much of it. When you build up to a serum level, it’s SO POTENT.

Americans should look at European countries’ use of buprenorphine. They’ve had it much longer than we have. They use lower doses; they have as much maintenance as we do. In Scandinavia, what do you think the number-one most-abused drug is?—buprenorphine. Simple facts: they’ve had it longer, and it’s the most abused drug. That’s what I’d like people to know about.

Buprenorphine is now the 41st most prescribed drug in the U.S. Five years ago, it was the 196th most prescribed. [Update, April 2016: Suboxone is now the 16th most prescribed drug in the U.S.] So you can see what a money machine it’s becoming. … The research to get Suboxone approved [by the FDA] was funded in conjunction with the NIH. Until the NIH is run by someone in recovery from addiction, this propaganda will continue. [National Institute on Drug Abuse Director] Nora Volkow is great, she’s smart, I’ve met her, but she doesn’t have a clue.

G: Why don’t you prescribe Suboxone as a maintenance drug?

S: I wasn’t against maintenance when I detoxed. But I’ve seen a lot since then. And I had a detox physician who told me, “Do NOT stay on this drug for more than three weeks, or else you’ll be dealing with a whole different problem.”

Buprenorphine is a partial-agonist opiate. It binds to the receptor and only activates it partway. Opiates are meant to bind to the receptors and activate them fully. But if you put something completely foreign in the body like a partial agonist, the body says, “What is this?” and it tries to reach homeostasis. It struggles to understand it as a full agonist, and it can’t. There is nothing in nature that is a partial agonist, and our opiate receptors are not designed to operate with partial-agonists. Buprenorphine definitely does something unnatural to the body.

I’m not against maintenance for a certain percentage of the population. I have a friend who runs a methadone clinic, and I think there’s a percentage of patients who need to be on maintenance for the rest of their lives. Perhaps five percent of the [addicted] population. If you want to do maintenance, though, you want to do methadone. Methadone at least has been used for a lot longer, and we understand it better.

G: How do you conduct detox?

S: To detox patients off long-term Suboxone, I use clonidine [a blood-pressure medication] and Librium [a benzodiazepine] because it’s more water-soluble. And I use Darvon, a weak opiate. Its half-life is short. … The Librium is the last to go. And they complain of disturbed sleep. I don’t use Seroquel because it can be abused. I use what acts on the antihistamine and melatonin receptors—the only two receptors they haven’t messed up yet. … It can take five months to get someone off long-term Suboxone.

For a Fentanyl detox, I give them Subutex. Fentanyl detox is the most brutal detox but it has the quickest recovery of the receptors because Fentanyl has such a short half-life.

I tell them to exercise. Studies show that 12 minutes of exercise per day with a heart rate of greater than 120 beats per minute restores the natural endorphin system in half the time. The people who do that, their sleep architecture returns to normal in half the time of people who don’t exercise. Twelve minutes. And of course you can do more.

G: And you urge them to join a recovery program?

S: They need some kind of support system. Let me tell you—everyone who’s stayed off Suboxone, they’ve been in AA or NA. Thirty-day inpatient programs have an average rate of 5 percent sober after one year. But from what I’ve seen in my practice, anyone who does an honest fifth step in AA or NA stays sober—the numbers are greater than 50 percent. And anyone who can do an honest ninth step and make amends, the number shoots up to over 90 percent.

Everyone who comes to me, I get them off opiates. One-quarter of the people I treat are sober at six months, and ninety percent of those are actively involved in some program. They’re not just going to meetings or involved in community service—they’re actively seeking some kind of spiritual growth. It all comes down to whether people want to do the work.

G: What about people who are afraid of becoming depressed after detoxing from long-term use?

I ask them, Was there ever a time you were sober? Did you have a bout of depression before then? If not, then it’s probably substance-induced. You have to take a thorough history. The statistics say: of all people who get clean, 15 percent have mental illness. Maybe a bit higher than the general population.

This site has always been free. If this post helped you, please like and share.

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Related posts:

How To Detox From OxyContin and Other Opiates

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

Have questions, or want to see someone interviewed here? Email me at guinevere (at) guineveregetssober (dot) com.

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