Addiction Recovery Manual

Chapter One

What is Addiction?

Addiction is where you can’t get enough of what you don’t want anymore.

Deepak Chopra, M.D.

The Demon Comes to Meet Aaron.

Aaron’s story is typical: a high school footballer injured on the fifty-yard line, he came home from the hospital with a bottle full of Lortabs—enough to choke a horse.

A pill relieved the knee pain, and also produced a relaxed, happy feeling. Another pill gave him a euphoric glow, a nice little high. His doctor renewed his prescriptions for a while after the pain was gone. Soon, he took the pills to relieve the ugly lows that inevitably followed the lovely highs.

When his doctor stopped prescribing, and he ran out of Lortabs, he bought other pain pills from his school buddies who used – Percs, Hydros, Oxys or Hillbilly Heroin. These produced similar highs.

When his money ran out, he found street Heroin—also known as Brown Sugar, China White or Horse—cheaper and easier to score. Aaron snorted the powder at first, then learned how to melt it down in a spoon and inject it for a greater rush. A belt helped as a tourniquet, but sometimes the veins in his arms became infected.

He dropped out of high school, forgot about college, did a few odd jobs. His grandfather got him on to train as a welder, but he couldn’t keep up with the schedule, and it was hot work. He kept falling asleep, and flunked a urine drug screen.

He now lives in the basement of his mother’s house, and does a little landscaping to keep her happy. His girlfriend has custody of their baby. While he was in prison for seven months on a methamphetamine possession charge, he learned that he had Hepatitis-C, but received no treatment. Heroin was harder to get in prison, but pain pills and a little Suboxone were available if you had the cash, or performed favors.

Now on probation, he attends court-ordered intensive outpatient therapy and presents to me at Transitions for Suboxone opioid withdrawal therapy. He’s also a smoker, drinks beer, and does some weed. He has a few tattoos he got in prison. His friends stop by and snort a little meth. Soon he will have to drop a weekly urine drug test for his probation officer.

Aaron arrives for his first medically assisted addiction withdrawal treatment.

He is one nervous dude, off all drugs for a week for fear of going back to prison. He is anxious, sweaty, and tremulous. He can’t sit still. He is yawning, with gooseflesh skin and a runny nose. He complains of vomiting and diarrhea, and is rubbing his joints and muscles due to diffuse aching. I note that his resting pulse is 102 beats per minute and his pupils are moderately dilated.

These signs and symptoms all add up to a Clinical Opiate Withdrawal Scale (COWS) of over 36—he is in severe withdrawal.

I admit Aaron to the Transitions program for Suboxone-assisted opiate withdrawal induction therapy, weekly visits and urine drug tests. I also prescribe Topiramate for cravings and Zoloft for anxiety and depression. He is scheduled for individual counseling and local Narcotics Anonymous (NA) meetings, also required. The therapist will employ cognitive behavioral therapy and behavior-modification strategies; and NA will introduce him to the twelve-step recovery program. He has joined our healing family, and we will see him through to sobriety.

With the triad of Suboxone, counseling, and NA, Aaron has a chance to pull his life free from the death grip of opioid addiction — first his body, then his mind, and finally his spirituality. He has a chance to restore his family and clean up his legal obligations. He has a chance to find and hold a decent job. He has a chance to see his baby again. His chances for relapse in the program are about the same as with treatment for diabetes, hypertension and asthma. But he is in our program, and notwithstanding relapses, has a good chance for complete recovery.

Enter the Demon: The Process of Addiction

Addiction is recognized today as a brain disorder in which the addict compulsively seeks the addictive substance or activity in spite of negative consequences.

We think of addicts as the drunk clown with a lampshade on his head at the party, or the somnolent druggie shooting heroin intravenously in a Skid Row flophouse and nodding off to Neverland. Addicts are present in many of the cars you pass on the road, in your neighborhood, in your family and perhaps in your home.

Addicts use drugs— alcohol or opiates—to seek pleasure, to escape the ugly reality of their dull, painful or tragic lives, or, they think, to enhance their mental or sexual performance. They may be self-medicating their own mental illnesses without knowing it.

Dr. Chopra, however, views addiction in part as an unrecognized spiritual craving. The addict is a person on a spiritual quest, seeking joy through pleasure. But like the lyrics in the Waylon Jennings song, the addict is looking for love in all the wrong places.

The Demons Have Names

The Diagnostic and Statistical Manual (DSM-5) currently lists the Substance Use & Addictive Disorders as including:

Alcohol

Cannabis: Marijuana

Hallucinogens: LSD, PCP, Magic Mushrooms, MDMA

Inhalants: Computer Duster

Opioids: pain pills: Lortabs, Vicodin, Hydrocodone, Oxycontin, Norco, Percocets Fentanyl, Carfentanil

Sedatives/Hypnotics: Xanax, Valium, Phenobarbital, Zolpidem

Stimulants: Cocaine and Methamphetamine

Tobacco, and

Gambling

Also listed as disorders, but not true addictions, are the Impulse Control Disorders: These include:

Binge Eating Disorder

Compulsive Sexual Behavior

Problematic Internet Use

Problematic Video Game Playing, and

Compulsive Buying Disorder

The Demon Takes Many Forms: What the Addictions Have in Common

Curiously, all of the addictive disorders and some of the impulse control disorders share the same genetic background, move along the same brain pathways, and respond to similar treatment.

In this manual, we are concerned with alcohol and opioids, but research continues for treatment of all of the substance abuse and impulse control disorders. Gambling disorder, for instance, has been shown to respond to behavioral and psychotherapy, 12-Step programs, and treatment with the opioid antagonist Vivitrol, antidepressants and mood stabilizers. This is similar to treatment for alcohol or opioid addiction.

The Demon Moves In: Progression of Addiction

Addiction to alcohol or opioids is characterized by a predictable progression over time of increased use, followed by dependence on the substance, then tolerance followed by continued use despite negative consequences.

Whether it’s alcohol or pain pills, the fledgling addict uses more of the substance to produce more of the desired effects: a few beers after his killer day in the office or factory or the pain pills that help her escape from her abusive husband. Later, they come to depend on the alcohol or drugs, and schedule their day around drinking or using times. After a while they become tolerant, requiring more alcohol or drugs to give them the same help. If they try to cut back or stop, then withdrawal symptoms arrive like a bad case of the flu, or worse. Their habit becomes the biggest part of life, interfering with daily functions, family, and work. They have to use more, are truly addicted, and continue compulsively drinking or doping, as the fog of addiction rolls in, and their lives falls apart.

The Medical Model

Addiction is a medical disease, similar to diabetes, heart disease, or cancer. It is not a moral failure or defect of Aaron’s character, neither is it a bad choice he made on purpose. He engages in the compulsive use of heroin despite adverse consequences, because the opiate has re-wired his brain centers for reward, decision making, and control. The heroin has damaged his brain tissue, just as heart muscle becomes scarred from lack of blood supply in a heart attack. On top of that, the brain has been grooved in a fashion that makes it seek more drugs.

Myth: The Addictive Personality and Moral Failure

There’s no addictive personality type that makes you more likely to become an addict. We all have a personality as unique as our eyes, fingerprints and DNA. Personalities are complex, and while there are personality disorders that accompany addiction, they don’t seem to cause it. Dr. Angres points out in his excellent book, Positive Sobriety, that self-centered, narcissistic personality types, those with exaggerated self-importance and lack of empathy for others, may be associated with the progression of addiction. Co-morbidities associated with opioid addiction include depression, anxiety and PTSD, as well as tobacco, alcohol and marijuana abuse.

While there is no true addictive personality, it is clear that addiction, once...