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The Bergand Group – March 2015 Newsletter

After Abstinence What’s Next?

By Dr. Jerry Hunt

Becoming abstinent from drugs and/or addictive behaviors can be very difficult and many of us fall back into use following our early attempts at sobriety. Some people with addictions are able to stop on their own with little or no help. Others may find it impossible to stop on their own. And many in both groups find it difficult to “stay stopped.” There are many reasons.

“Our Addiction is but a Symptom…” Feelings of depression and anxiety are common when we first become abstinent. As our brain begins to heal, we may experience cognitive and emotional challenges such as memory difficulties as well as sleep disturbances. These issues, called Post-Acute Withdrawal, often clear with time and proper self-care.

However, sometimes, anxiety, depression, bipolar disorders, and even some psychotic disorders underlie our addiction and reveal themselves when we become abstinent. We may have been using in an attempt to treat what is really a mental health problem. Under these circumstances, it is best to consult with a psychiatrist who is also trained in Addiction Medicine. A proper diagnosis and recommendations for treatment will result. Medications are available to treat many mental health problems and these medications are often more effective than street drugs.

Addictions May Be Layered. Sometimes, we start out with one addiction, perhaps to food or sexual activity and add others, e.g. alcohol and drugs. These may serve to numb our feelings of shame and guilt regarding our initial, uncontrollable, compulsions. When we become abstinent from alcohol and drugs, the initial attachments are revealed and must be addressed if we are to truly experience recovery. Often Twelve Step Programs exist to deal with issues that may underlie these initial compulsions.

Substitute Addictions. If we experience any of these challenges to remaining abstinent, we may be tempted to select a substance or behavior that, while not “as bad” as our initial attachments, still has the hallmarks of obsession and compulsion. Perhaps these are even viewed “positively” socially and culturally. For example, we may work and/or exercise with the same compulsion and obsessive determination as we did with our drug of choice. Except, now there are rewards (e.g. more money, promotions, weight loss, and physical fitness) instead of consequences associated with our new-found habit.

Even substances necessary for our survival may emerge as a substitute addiction. Certain foods, especially sugars and fats change brain chemistry in a pleasing way. We may begin to consume these foods in excess, even without realizing it. Combined with physical exercise, we may not experience the weight gain often associated with this attachment.

The signal that we have selected a substitute substance and/or behavior is the unmanageability. Are there unwanted consequences connected with the substance or activity? Do we experience our lives as being out of balance?

What to Do?

First Things First. The most serious of the substances and/or behaviors must be addressed first. If mental health issues exist along with the addiction, these must be treated at the same time. Serious depression and/or anxiety will lead us back to our drug of choice unless it is addressed along with the substance problem. Again, a psychiatrist trained in Addiction Medicine will be able to assess the mental health issues, differentiate between the more transient and the more long-lasting and prescribe an effective medication where appropriate.

Harm Reduction. As noted, we may select one or more of the “substitutes” (e.g. foods, work, exercise, etc.) as a way of dealing with unwanted feelings following initial abstinence. Provided these attachments are not seriously injurious, they can be considered “harm reduction.” That is they still have an obsessive/compulsive look, but they are not as destructive as our initial addiction.

The early going is difficult for many, the power of Twelve Step Programs hasn’t been fully realized, and “life-on-life’s-terms” keep happening. Trying to be too virtuous under these circumstances can lead us back to our drug of choice. “One Day at a Time” and “Easy Does It” may serve us better in the long run. Eventually, these “substitutes” can be surrendered as we grow in the program.

Stick With the Winners. “An addict alone is an addict in trouble.” Participation in Twelve Step Recovery Programs is crucial for recovery for many. Surrounding oneself with others who are recovering and letting them know what we are experiencing is an excellent way to get through this early period.

Twelve Step Programs are spiritual and the essence of spirituality is “surrender.” We first surrender our use of our drug of choice, then the “substitutes.” Then, sometimes, one at a time, our character defects.

As humans, there always seems to be one more thing that can be surrendered.

Dr. Jerry Hunt
The Bergand Group

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