I Am Not the New Me

but I’m not the old me either…

dealing with urges Sunday November 18, 2007

I found this on StumbleUpon (one of my favorite addictions!) and it seems pretty good. I am putting it here for all to read, but I am taking no credit for the contents. I know that reading this when I am feeling weak will help me, and maybe it will help you, too.

COPING WITH URGES

Robert Westermeyer, Ph.D.

Habits and urges go hand in hand. In fact, many people in the throes of an addictive behavior problem, whether it is overeating, drug use or alcohol abuse, claim that they derive no pleasure from their habit–that it is nothing but the relentless craving that fuels ongoing addictive behavior. What is usually most difficult for people when changing a bad habit is coping with the sometimes relentless urges. The initial days of a habit kicking plan can be exhausting as urges dominate thinking and interfere with daily routine. Many people give up change efforts because they feel that there is not way they can function without their habit as the urges interfere too much with quality of life.

It is important to remember that urges, in and of themselves, are normal. We experience craving in varying degrees every day. And because your habit has been important to you for a long time, it may be unreasonable to expect urges to vanish completely. What is hoped is that you will come to experience urges with less frequency and that when they are experienced you will be able to react in a way that avoids relapse.

The “three Ds” can be helpful in coping with urges and craving, whether these urges are related to alcohol or drug use, overeating , tobacco use or any habit you are attempting to change. The Ds stand for Decatastrophizing, Disputing expectancies and Distracting.

Decatastrophizing

Especially early on in your change efforts, craving can seem excruciating. Your daily routine has been altered by the elimination of an important part of life and now you can’t get your mind off it. Everything you see reminds you of your habit. If you smoke, every room you enter may bring to mind the image of a cigarette and associated pleasure. The inability to satisfy the urge can lead to frustration and inner statements like, “I can’t stand this!” or “There is no way I will be able to live without giving in. I’ll just go crazy!” Statements like this can be overwhelming. So much so that people often give up efforts.

As is the case with anxiety, catastrophic thoughts can lead to a great deal of arousal which can, in turn, make things seem worse than they are. If you believe that you are completely out of control, your emotions will follow. What is important to remember is that urges are normal and typically decline in intensity as you continue implementing change. To combat catastrophic reactions to urges it is important to remind yourself of times in the past when you have successfully changed habits (think now, we all have done so at least once or twice!). Do you still experience urges? If so, are they as intense as during the initial phase of your change efforts? Probably not, right? Furthermore, think about other people you have known who have undergone significant change. Do they seem haunted by urges such that they cannot function? If not, who is to say that you cannot accomplish that also?

Try to take some of the power away from a black and white adjective like “horrible” or “unbearable.” Belief in horrible extremes only makes you feel worse. Just how unbearable is your urge right now? To accurately answer this you may need to conjure images of what other types of suffering reported as unbearable are like. Is this as unbearable as getting stabbed in the stomach? Or better still, what have you endured which was worse than your current urge? Was that unbearable? If so, does it follow that your urge is less than unbearable and perhaps only “very uncomfortable.”

Disputing Expectancies

Craving is, in essence, the activation of expectancies. Beck and his colleagues (Cognitive Therapy of Substance Abuse, 1993, Guilford Publications) believe that there are three beliefs associated with “the acute decision to engage in substance abuse.” They are Anticipatory, such as “I’m gonna be Mr. Wonderful after one line.” Relief Oriented, such as “I won’t have to think about work if I drink this bottle of wine.” and Facilitative or Permissive, such as , ” I’ve been good all week, I’m entitled to an evening high.” Though Beck and his colleagues presented these fundamental beliefs in reference to substance abuse problems, it is this author’s contention that these beliefs can function in any habit urge.

Since we rarely think about distant consequences when craving, bring them to mind deliberately. Bring to mind the negative emotions which may be experienced at a later time due to engaging in your habit. Urges are “myopic” in that they can only see advantages. You must shed some light on your craving in order to effectively control it. Ask yourself questions like:

* How will I feel later if I give in to my urges?”

* What consequences might I suffer if I give in?”

* Will the negatives outweigh the positives in the long run if I give in?”

Another way to cope with urges is to imagine that someone very close to you is voicing the very urge you are experiencing. How would you go about convincing them not go give in. Sometimes distancing ourselves from our urges is imperative before you can subject them to any scrutiny.

Your ability to conjure vivid images can be used in your favor when you experience craving. In the presence of a strong urge, try to imagine a very negative outcome. The more negatively graphic the better. The more true to your life the better. For example, if you have a problem with alcohol and experience a strong urge to walk down to the convince store and buy a bottle of Vodka, imagine the worst hangover possible. Imagine vomiting all morning. Better still–imagine someone very important dropping by, someone you really want to impress, and seeing you in that condition. It is amazing how powerful our own imagination can be in fueling and impeding behavior. Use it to your advantage in your habit change efforts!

Distracting

Some urges are so relentless that talking back to them is insufficient. You still can’t get your mind off your habit. Good old fashioned distraction is sometimes the only medicine that can pull your thoughts away. Distraction can be cognitive, in the form of some mental exercises, or behavioral, in the form of activity. Certainly the latter is going to be the most effective, in that urges tend to occur in environments with are the same or similar to those in which the habit occurred in the past. If you are trying to quit smoking, and you have previously smoked at in your office all day, being in your office is going to elicit a strong drive to light up. Certainly if possible, taking your work into a conference room, or taking a break and walking outside will often be enough to decrease the urge to a manageable level. You must evaluate your schedule and determine which situations evoke the most intense craving and create as much flexibility as possible so that you can “escape” if necessary–especially in the initial days of your change efforts.

Cognitive distraction can be very powerful. Certainly imagery has been used as a means of helping stressed people learn to relax. You too can use imagery to take your mind off an urge which is dominating consciousness. Conjuring a pleasant place like a beach or on a raft in a lake can help you not only take your mind off the urge but relax as well.

However, “relaxing” images are not helpful for everyone. Some find that if they relax when craving they will only want it more. This makes sense as we have discussed that many habits are associated with relaxation and pleasure, and evoking these feelings in places previously associated with your habit can strengthen urges tremendously. I recommend that you find some mental task that will be very difficult to finish but which is interesting and consuming that you can activate in response to an urge. I like to refer to these as Mental Tapes. Some examples of tapes which have been helpful are:

* Writing the perfect epic novel or screenplay.

* Planning the perfect vacation.

* Creating the ideal money-making business

* Interpreting a dream from the night before

* picking an acquaintance and trying to “figure them out.”

Certainly what you choose will depend on your interests, but the key is to make it something that will be easy and perhaps interesting and fun to do. Choosing to think about all the mistakes you’ve made this year and how you could have done things differently is not going to prove a good distraction tape as it won’t be enjoyable. In fact it may increase the power of your urge, especially if stress has precipitated your habit in the past.

It is sometimes best to try one urge control technique at a time so that you don’t get overwhelmed. These techniques work, but they also require a great deal of mental energy and conscious effort. The aim here is not to make change excruciating or extraordinarily taxing, but to provide you with some tools which you can add to your armory at a your own pace.

 

the progress report Thursday November 1, 2007

I had therapy again today. I LOVE my therapist. She is so understanding and thoughtful, and I am so grateful for the opportunity I have been given to be able to work with her. For free! Today was my second appt. with her and I feel like she is already really understanding what I need from her. I am totally willing to show up, which she is so happy about, but I also am open to really doing the work that needs to be done. We had a really good session today, and I swear at one point I saw a tear roll down her cheek. Now she would never be so unprofessional as to actually address that, but I saw it and it meant so so much to me. I have looked so long and so hard for the help (a qualified therapist) that I need. For one reason or another nothing ever worked out for me. But here before me is this grand opportunity, all I have to do is show up, work hard, and be honest. I can do that.

As for the Suboxone, I am now getting 4mg/day in addition to the implant and will be receiving the 5th implant on Tuesday. Hopefully that does the trick as far as the dosing goes. I am so looking forward to no more orange-vomit tabs. There is  a part of me that is stressing that the dosing won’t be enough still, or it just won’t work, or whatever, but I am trying to ride it out. There really is no way to predict, but it looks like I am in a pretty good position to be helped by the 5th implant. The fact that I am doing really well on 4-mg orally kind of tells me that the 4 sticks in my arm are doing something, they just aren’t doing enough. So I will cross my fingers and toes and try not to spin out about it. It will be what it is meant to be. As bottlecappie put it, I have been randomized.

 

an open invitation Tuesday October 30, 2007

To any of you out there in web land who are reading this blog.  If you are in recovery, if you are trying to decide if Suboxone is right for you, if you are depressed, if you are a mother who struggles with mental illness or addiction, I want to hear from you.  I need support.  And I truly believe that support is a flow of energy.  That means that if I can help you with my words, then you can help me with yours.  Leave me a comment, send me a link to your blog or page.  I want to widen my safety net, and I am really getting attached to reading the kind words that are left for me when I am struggling.  It really does help.  So, to all of you out there, say hello, or help, or whatever it is that you are thinking.  I need you all.

 

quick Monday October 29, 2007

Filed under: Suboxone, addiction, change, friendship, healing, housework, progress, recovery, treatment — angstandjoy @ 3:54 pm

I only have 3 minutes before I have to go get the kids from the bus. BUT I saw my people today (study coordinator, doctor, therapist), all of whom were very sorry for what I went through this weekend. My doc immediately gave me 4mg dose of Sub in the office, along with 6mg to take home (1mg later today, and then 5mg for tomorrow). I started feeling better in no time flat. I am so relieved and happy that all of this weekend’s drama is over. So, it looks like I will be supplementing with the Suboxone for 2 weeks, and then I will get a 5th implant put in, which should solve the problem. Woooooohoooooo. I can’t even put into words how relieved I am. I was getting really spun out on the idea of having gotten a placebo and having to figure out what the hell to do next. So, I gotta run, but thanks for all of the kind words when I needed to hear them so badly.

Oh, and hello SuboxoneMom. I am glad to have you reading and helping me with your experiences. The more support the better, right? Do you have a blog I can read? I can’t seem to find a link…

 

Day -2 Monday October 15, 2007

Had my big appointment today. Blood work, EKG, interviews, the whole shebang, Met my doctor and found out all about the Suboxone program. I am feeling very strange about all of this. I want so badly to be released from my monster of addiction but my fear of my depression and anxiety is making me panic a bit. I hope that I can find the joy in my life again, that I can learn how to be human again, but I fear that I may be shooting too high with these wishes. I begin induction on Wed and I am seriously fighting the urge to get really really high because I know that it’s over. I hope that I can make it through. I am so close now. I feel good knowing that I have, like, 5 people to call if I am having trouble, but I am still worried. The urge to lie and hide things is very strong, I have promised myself to be completely honest throughout this process but I keep worrying that I will decide to lie for no good reason. Old habits die hard, I guess. The countdown is on.

For my entire life I have suffered from chronic depression, which after the birth of my children began to cycle at an increasingly rapid pace. I tried every antidepressant on the market, they all had tons of side effects, but my depression remained the same. As things got worse and worse I began to experiment with opiates. Amazing! I was feeling great, tons of energy, and life was great. For a while. And however many years later, here I am. Having the worst depression of my life. Doing waaay too many pills just not to get sick. At the end of my rope. My husband is fed up. My kids miss me. I am not doing well in school. I am ready to be done, but every time I quit I get suicidal. Panic Attacks. Nonstop crying for days on end. Puking.

The bottom line is, I have been looking for help with my depression for so long, and I know that the depression is what led me to my opiate use/abuse. There is tons of research out there that says that Sub can have a tremendous effect on treatment resistant depression as well as helping me with my opiate problem.

I kind of feel like this is my last chance or something. I have tried so many things. This feels like hope. The program consists of 3 visits a week; 3 urine tests, 2 counseling visits, and a treatment visit to assess medication issues and such. My program will be one year at minimum (with the counseling, urine tests, and treatment visits) and possibly lifetime maintenance (medication only), we’ll just have to see how it goes, and how the suboxone affects my depression. If that can go away I will stay on forever! All of the people I have met so far at the clinic have been incredible, inspiring and hopeful. I didn’t get any of the attitude that I was expecting (who knows why I thought that?) I am truly hopeful for the first time in a long long time.