Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: drug addiction (page 1 of 2)

Insomnia in Recovery: Three Things I Do To Sleep Better

Insomnia in detox rehab recoveryChemical detox can mess up our sleep cycles. When our bodies get rid of the chemicals we’ve ingested for so long—whether nicotine, alcohol or drugs; street drugs or prescription drugs—our neurological systems need time to heal. And one of the cycles governed by the healing neurological system is the sleep-wake cycle.

This can also be true of folks “detoxing” from toxic, codependent relationships. My experience in Al-Anon helped me understand that the compulsive need to solve other people’s problems is analogous to drug-use: it makes me feel better to make someone else feel OK; it distracts me from being present in my own life and taking care of myself, just as drugs did. This constant focus on other people I can’t control can make me anxious, chronically raising cortisol (adrenaline) levels and short-circuiting my body’s ability to regulate its energy. Setting healthy boundaries with people can be freeing, but it can also feel dangerous and unfamiliar. I’ve spent sleepless hours in the night worrying about other people and how I can fix them up and make them all better.

When we’re detoxing or working a difficult problem in recovery, we can feel tired during the day and restless during the night. It takes time and work for the nervous system to “reset” itself.

And when I was detoxing, my first instinct was to “take something,” preferably another chemical, to make me feeeeel better. But in recovery I’ve tried to break the habit of “taking something.” I want to find non-chemical ways to deal with my problems.

Here are a few ways I’ve dealt with insomnia:

The Body—Exercise. In detox, I started exercising at least five times per week, for at least 30 minutes per session, and I’ve tried to keep up this regimen for the past two years. I notice that, during the times I slack off on my exercise regimen, my body feels colder and more sluggish. It’s kind of counter-intuitive, but when I feel really knackered during the day and unable to sleep at night, it’s not rest that does me good but getting out on the tennis court, hopping on my bike, doing half an hour of yoga, or taking a fast walk. Anything that makes my body sweat and stretch. Regular exercise has been shown to be just as effective as antidepressants at lifting the mood and restoring natural sleep.

Steven Scanlan, M.D., medical director of Palm Beach Outpatient Detox and a board-certified addiction-medicine specalist, says exercise works better than any drug to help bring back sleep cycles. “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,” Scanlan, who has overseen thousands of detoxes for people addicted to alcohol and opiates, told me.  “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.”

Sleeping in detox recoveryThe Mind—Meditation. A daily discipline of calming the mind in order to calm the body accrues benefits after the actual meditation is finished, the way exercise accrues benefits for the body after the actual workout is done. A meditation practice has taught me I don’t have to grab onto every thought that comes into my mind. I can choose which thoughts to admit. So when I’m wakeful in the night, I focus on my breath. I make the breaths come slowly and through my belly, not my chest. When the fearful thoughts come, the meditative practice I’ve cultivated helps me let them go.

The Spirit—Gratitude Lists. I’ve had quite a number of wakeful nights recently. Moving into new arenas and accepting challenges wakes up the old fear inside me. The fear attacks my faith that, as the old saying goes, “All will be well, and all manner of thing will be well…”

Instead of writing inventory on my fear, I’ve been directed to pay attention to my gratitude. I’ve been writing little gratitude lists each night before bed. … The other night, when I woke up, I had this wild sleepy idea that I could breathe out a mental gratitude list. I slowed my breath down, and on each exhale I thought of something for which I was grateful. After about eight or 10 breaths, I wasn’t sure I could come up with anything important. But the things we’re grateful for don’t have to be earth-shattering. Here were some things I thought of in the middle of the night:

  • My warm bed
  • My comfortable sheets
  • My husband sleeping next to me
  • My son in the next room
  • Our house
  • The good roof on the house
  • Our furnace
  • My friends
  • My sister coming to visit
  • My computer
  • Our piano
  • My son’s guitar
  • My son playing his guitar
  • Singing with my husband
  • My art room
  • My paints and brushes
  • Being clean and sober
  • Our garden
  • My warm socks
  • My yoga mat
  • My bike
  • Our big city yard
  • Our books
  • Supper
  • My soft pillow

The fact that I was able to generate an interminable list amazed me. The longer I went on, breathing out my gratitude, the calmer I felt, and the more sure I became that we would be OK. The more I could release my fear into faith that something else other than myself, a lot bigger than myself, was taking care of us. Taking care of me.

And I fell asleep…

Sleeping in detox rehab recovery

Sobriety and Success: Emmylou Harris and Gram Parsons

Saw Emmylou Harris in concert the other night.

Emmylou Harris

Emmylou Harris preparing to sing Townes Van Zandt’s “Pancho and Lefty”

Saw her one other time, about 10 years ago when she toured with Elvis Costello. She sings well with men. On this year’s tour she’s (again) backed by a group of men whose voices harmonize well with her reedy, pure mezzo-soprano. She’s 63; she’s been touring for more than 40 years; and she hasn’t shredded her voice the way so many others have by belting and screaming. She lets it do what it was made to do. She accepts its changes.

She’s still gorgeous. “That hair!” a friend of mine said, when I told her where I was going that evening. My hair has gone grayer in the past six months, and I haven’t colored it. It was good for me to see a talented woman use her abilities to give others pleasure, and rest so comfortably inside herself while she was at it.

I discovered Emmylou Harris about 25 years ago, when I was involved with a guy who drank and played the guitar a lot when he was off work. Of course I drank with him. He had a bunch of vinyl, and amongst his albums was the classic Grievous Angel by Gram Parsons. My boyfriend’s voice wasn’t much good but I loved singing harmony, so we sang “Love Hurts” and I figured out Emmylou’s part and ignored my boyfriend’s voice (and also his drinking, and also my drinking) and heard only Gram Parsons singing in my mind, because Gram Parsons had a beautiful voice—a “high-lonesome” voice as Keith Richards once called it, a voice full of “beautiful pain”—and also a pretty face:

Gram Parsons

Gram Parsons in his Nudie suit

I have this powerful ability to ignore what’s really going on, which is why they say

Denial Ain’t Just a River In Egypt

(“Denial ain’t just a river in Egypt?” my son said the other day, when I repeated this to him. “De-nial… haha,” he said. “Never heard that one, pretty good, Mom.” “Dude,” I said, “I didn’t make it up.”)

So I made up this whole story about how Gram and Emmylou were in love and how their love propelled them to success—because in my 23-year-old mind nobody could sing “Love Hurts” and “Hearts on Fire” the way they did without actually being in love. In fact the story is this: Gram was a stone smack and morphine addict, also an alcoholic, and wasn’t getting it “together” to rehearse their act; then they found Emmylou, and what Emmylou brought to the act was not just her beautiful voice but an actual work ethic. Discipline. She made them practice a beginning, a solo, and an ending for each song they played on tour, and everyone from the band who’s still alive credits her discipline with saving the band from being fired from every gig.

“When Gram was together [not wasted], there was nothing like his presence onstage,” Emmylou says in Fallen Angel, a documentary about Gram Parsons. “He had this extraordinary command, this amazing charisma.”

Gram Parsons never got sober—he overdosed on booze and morphine in 1973. This fact doesn’t prevent me from loving his music. I just wish there were more of it.

I thought about this story the other night while Emmylou came back onstage to play “Pancho and Lefty.” She’s still with us, able to do what she does … maybe just because she DOES IT. She keeps putting one foot in front of the other. She got paid a measly $500 for her first gig with Gram, and she wasn’t sure what to do with that money, so she went home and bought a guitar, and step by step she parlayed that first into an entire career, with hard work and faith in the work itself. It wasn’t magic. It was “simple, but not easy.” It was sober. … Emmylou Harris was never an addict, but it doesn’t matter—f0r me, she’s a model of sober life.

Emmylou Harris and her dogs

Emmylou Harris with her band and her dogs at the end of the show. She also has children, grandchildren, a house, friends—a full life…

Sobriety doesn’t guarantee success. Sobriety guarantees the ability not to drink or use. To do that, I have to have discipline. And it’s the discipline that will lead to something greater.

This is one of my favorites of hers, from Cowgirl’s Prayer (1993).

Sayings from the Rooms: On F.E.A.R.

They say,

Fear =
False Emotions Appearing Real

Talked last night and again this morning with a long-time friend of mine who also grew up in an alcoholic family. We’ve both had some family difficulties recently… When it involves kids, it hits us especially hard. We need our kids to be happy in order to be OK.

Kids who have grown up with addiction quite often need the people around them to be happy in order to be OK.

One lesson of recovery: we can’t control other people, places, or things. We can only control our own behavior.

But both of us feel that same feeling in the pit of the stomach: that’s where the F.E.A.R. resides.

Steps 6 and 7 teach me that I can control my behavior, but sometimes I can’t control my attitudes. That’s when asking for help from a power greater than myself becomes necessary.

***

A different friend of mine and I were discussing a situation in which yet another friend of ours had secured therapy for their child. I was recalling how my own parents had been entirely reluctant to entertain the idea that any of us might need therapy, despite considerable acting out in the family. I remembered how my father banged his hand down on the table and said, “You don’t need a psychologist, you need GOD!”

“I think Dad didn’t hold much with psychology,” I said. “Psychiatry was even worse. And I think my mother didn’t want to spend the money…”

[you don’t deserve it]

“Sometimes God costs money,” my friend said mildly.

Life saverThere’s that old story about the guy who’s flooded out to the top of his house, and along come a raft, a boat, and a helicopter, all of which he turns down, telling himself he’s waiting for “God” to save him. After he drowns and gets to heaven, God chews him out: “I sent you a raft, a boat, and a helicopter—what were you bloody thinking??”

Sometimes God comes in the form of a doctor.

Sometimes God comes in the form of a friend on the other end of the telephone.

Sometimes God comes in the form of a Group Of Drunks.

***

Fear passes… it’s “just” a feeling. Feelings aren’t facts.

God saves me from my F.E.A.R. in all kinds of ways… up to me to keep an open mind in order to see it.

Also up to me to ask for help…

“It’s just as much self-will NOT to accept help as it is to go drink or use,” a friend of mine with 20-some years is wont to say.

Sharing the “We”: Recovery Bloggers I Read

In line with a suggestion I received recently that I focus on what I’m grateful for, I wanted to mention some other blogs I visit regularly and for which I’m truly grateful. Community is important in sobriety. I read lots of blogs and will just mention a few today… These folks not only provide worthwhile reading and entertainment, but they also quite often save my sanity by giving me much-needed perspective at, so it seems, just the right time… I hope you’ll explore these too.

Mr. Sponsorpants

Mr. Sponsorpants is the alias for a guy who is about 25 or 30 years sober. His recovery process is Alcoholics Anonymous. He’s been around just about every block imaginable with regard to “helping others,” and he’s entirely no-bullshit, clear and super-direct, but at the same time (and somehow it’s not a paradox with him) extraordinarily compassionate. I’ve often wished he could be my sponsor, or pinch-hitting-sponsor, or fairy-godsponsor, or whatever. I feel shy about sending him emails because he knows so much (and I know so little) but I’ve sent more emails to him than to any other blogger, because I have lots of questions about sponsorship. Just writing the emails helps me formulate the questions and be open to answers… His latest post is full of humility and honesty. He’s able to show himself getting pissy and sarcastic and truly depressed, but we never lose compassion for him. He posts very often and I hardly ever go a day without reading this guy… gratefully.

Syd, Who Is Just F.I.N.E.

Confession: I feel like Syd is the sane big brother I never had. Syd doesn’t know this and might could care less, but I feel so much affection for this marine biologist cum photographer and writer. I don’t know if “Syd” is his real name or not, and I don’t know if the photo in his avatar is himself (I think prolly not, but who knows? it’s a great photo)… But from what I can gather Syd is a marine scientist living out his early retirement on the Carolina coast and who is married to a recovering alcoholic. His blog is about recovering from the family disease of alcoholism, from an AlAnon orientation. He has four or five years in the program and he doesn’t sit around on his butt about anything, either—he sponsors lots of guys and he knows his literature inside out. He’s always got projects going. He’s into Action. His higher power rolls with the sea and flies with the birds; rises and sets with the sun. His blog—illustrated with his own photos of the sea, the marshes, and the wildlife in his beloved territory—is a peaceful place to visit when my world gets crazy. And his post earlier this week on self-pity gave me perspective that helped me a great deal. Thanks, Syd.

Works Aside

Bansky girl with heart balloon

My 13-year-old son thinks Banksy is a superhero because he uses the power of art for the common good without getting found out.

Nora, a native Londoner, writes a blog from her home in Switzerland about her relationship with her younger sister, Hannah, an IV heroin addict still living in London. Her avatar is a famous graffito of Banksy’s, the girl with a heart balloon, a print of which my mother-in-law gave me. Nora blogs out of a desire to understand her sister’s addiction and its roots in and effects on the family. Her descriptions of her sister’s behavior are hair-raising, and they betray her dedication to observing her sister and maintaining a deep connection with her—and ultimately to understanding her:

I didn’t want to believe that Hannah couldn’t be trusted but it fast proved true of her too. She has become so adept at lying she can look you straight in the eye and tell you she comes from Mars. And then she’ll go on to tell you what it’s like living in outer space, how she works with Martians and that you are actually from there too. And, all the while her face doesn’t flinch, her eyelids don’t flutter and when challenged she becomes outraged that you’d had the audacity to not believe her.

Nora’s perspective helps me understand my own addiction. … She also has a strong desire to change public perceptions of addiction so those who suffer can get help. You go, Nora…

Helplessly Hoping

Peg is the mother of a 30-something daughter who is a recovering heroin addict. She writes occasionally, but when her posts come, they’re intimate, and they wring my heart with empathy for the tightrope parents of addicts walk. Peg’s daughter has roughly five-and-a-half months off drugs and in a program of recovery. She lives in a sober house a few states away from her mother. Yet Peg spends a great deal of time thinking and worrying about her daughter’s sobriety… having earlier this year rescued her from a derelict drug-house and seen her daughter’s body in the worst of conditions. Peg’s daughter’s body has recovered… and now she’s witnessing the recovery of her daughter’s emotional and spiritual health—and hoping (helplessly) that it’s real… “Gasping at glimpses of gentle true spirit.”

Being Sober

In her profile Mary Christine says only that she is “a sober member of Alcoholics Anonymous.” The heading on her blog says she’s been sober since 1984. When you read her blog you find out that she’s a grandma, she knits (she knitted a GORGEOUS baby blanket for her new granddaughter), she suffers from migraine and is reluctant to take medications, and, don’t this beat all, she’s training for a marathon. This totally blows me away and inspires me. I think spiritual and physical fitness are intimately related…  I think Mary Christine abides by this too:

I am clear though that we could do none of any of this [living soberly] without the intervention of a loving God.

I believe that I am sober by the Grace of God. I also believe I can disregard this gift and throw it away any day by not caring for it. I need to care for my sobriety every single day. Just as I am training for this marathon every single day—even on days when I am resting…

Wow. Read her.

Coming to a Doctor’s Office Near You: Buprenorphine Implants!

Titan Pharmaceuticals, the California manufacturer of a product designed to release a steady stream of buprenorphine over a period of six months, yesterday released what they called positive results of a study of this product in yesterday’s Journal of the American Medical Association.

There’s lots of stuff that none of the journalists have reported about this study.

Beginning with the funding. The JAMA piece said Titan Pharmaceuticals funded this study. What it didn’t say was that last year Titan was awarded $7.6 million in federal funds from the National Institutes on Drug Abuse to study this product over three years. So a big chunk of federal money was awarded to a private pharma corporation.

Also: Titan and the UCLA study authors are calling the implants a success, but more than two-thirds of the implant participants received supplementary Suboxone tablets. That’s like saying, We gave them extra heroin to curb the cravings, but hey! the implants still worked. People do not understand: buprenorphine is an opioid, no matter what formula it comes in, no matter whether you call it an “implant” or a “medication” or a “drug.”

The product, which Titan has named Probuphine, is a 26-mm rod impregnated with the opioid buprenorpine. It’s designed to be surgically placed underneath the skin on the non-dominant arm. (Women have long used technology like this with contraceptive hormone implants.) Over time it keeps drug levels at a steady state in the bloodstream.

Titan’s people are calling this steady-state release one of the big advantages of Probuphine—no fluctuations in drug-plasma levels, the way there are with pills like Suboxone, or liquids like methadone.

Suboxone pills

Suboxone, the dissolving orange tablet whose drug sticks like super-glue to your mu receptors

They may have a point here. Suboxone has a 37-hour half-life. Let me explain how half-life works: When the drug is orally dosed every 24 hours, many physicians believe, Suboxone stacks up in the bloodstream—the body does not metabolize it faster than it’s dosed. But if it can be released in a steady trickle dose, then it might not stack up.

Titan and NIDA are also saying that because the drug is implanted, it’s impossible to divert. This is the big selling-point for the rods. Patients can’t hawk it on the black market, the way they do with Suboxone or other drugs. Code for this: they say it “improves patient compliance,” which means patients simply have no choice other than to take the drug, because it’s stuck inside the body.

How the study worked

The study involved a group of patients that received four Probuphine rods, and another group that received placebo rods. Both groups could also receive Suboxone pills if they were experiencing withdrawal or craving (up to 12 or 13mg per day!—an equivalent of about 525mg morphine. I mean, why even give your patients implants if you’re going to let them take an extra 12mg of Suboxone?) in the first 16 weeks of the study; for the last eight weeks, participants who elected to get an extra implant were limited in the amount of extra Suboxone they could receive. And everyone had to go to “counseling.”

Results of the study that everybody’s reporting (source: JAMA—I wish I could provide a link to the entire study, but the link above only gives you the abstract):

  • “Success” was measured solely in terms of urine tests free of illegal opioids (i.e., heroin). Results: 40 percent of implanted patients dropped “clean” urine, as opposed to 28 percent of the placebo group.
  • Withdrawal and craving scores for the implant patients were “significantly lower” (whatever that means) than those for the placebo patients.
  • Biggest result touted by the study’s lead author, Walter Ling, M.D. of UCLA’s Integrated Substance Abuse Programs: two-thirds of the implant patients stuck with the program (that is, continued to receive counseling—either that, or continued to receive their Suboxone), while only one-third of the placebo patients finished.

RESULTS NOBODY’S REPORTING:

  • Conflicts of interest in the researchers: Dr. Ling, the lead author of the study, is receiving research money from both Reckitt Benckiser (maker of Suboxone) and Titan (maker of Probuphine), and speaker fees from Reckitt. The other authors are also receiving either research money or speaker fees from these and many other big pharma companies, as well as NIDA (the federal government, whose projects are supposed to remain independent of commercial influence).
  • How these earnings influence the market: Buprenorphine, especially in maintenance form, is huge business. It is The Biggest Drug Treatment for opioid addicts right now, with sales of more than $900 million in the U.S. alone. That’s a 2010 statistic—it’s certainly grown since then. Reckitt and Titan are targeting not only “treatment resistant” addicts such as IV heroin users, chronic relapsers, and so on, but also to chronic pain patients who have become addicted to opioid medications—the fastest growing sector of addiction today. Enormous markets they’re mining. (In fact lots of curious investors read this post and come away with the conviction that, no matter what happens to the drug addicts, they better invest in Titan.)
  • Treatment assumptions: Built into Probuphine is the assumption that the only “real” way to treat addicts is to give them a drug for the rest of their lives.
  • Induction doses: All participants were inducted at fixed doses of 12-16mg per day of Suboxone over three days before they were randomized. Why give them this much to begin with? 12-16mg is an enormous dose of Suboxone. As in, equivalent to bags and bags of heroin, or around 525-750mg of morphine. Most people do not understand how powerful buprenorphine is.
  • How much bupe were they really getting? Finally, the authors admitted that with the way the study was conducted, it’s difficult to know exactly how much buprenorphine is getting into the body with the implant vs. Suboxone supplements. They say that their blood tests were consistent with “a constant buprenorphine release of 1 to 1.3mg/d from 4 to 5 implants.” If it’s true that the implant patients were getting only one milligram per day, then that would be brilliant, because that’s a low dose for addicts trying to get off junk … but it might also explain why nearly two-thirds of the implant group wanted extra Suboxone.

Especially if “counseling” was the only other solution offered to them.

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