Sunday, September 30, 2007

COPING WITH URGES

I came across another article today on the web that I thought was fairly interesting and also most probably pretty relevant for a good few of us. Personally, I have found that MMT has been fairly effective for me in eliminating my cravings or urges, once I'm on a stable dose of course. Now, this is not to suggest in any way that MMT helps eliminate the desire to do dope, cause I don't think that this ever really does go away once you've been insane enough to taste it but then that is an entirely different ball of wax, so to speak. This desire ends up being more of a psychological one anyway rather than a true physical one. While a good solid dose of willpower should be enough to keep one's desire in check, personally I need any help that I can get with the other. It's just too tangible and real and all where as the other is the opposite.

Anyway, on to the article...




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.

Robert Westermeyer, Ph.D.

ORIGINAL ARTICLE

Thursday, September 27, 2007

Deeper and Deeper

Well, after barely enduring the past 48 hours, I certainly have a new found respect for methadone that's for bloody sure. Maybe respect is not the most accurate description, but I do know that this will be the first and last time that I'll ever take my MMT for granted. I see now how easily I've allowed myself to become complacent about my treatment. Never again I say!

For the first time since I've returned to MMT, I missed going to the clinic to get my scheduled dose. Circumstances were such that I just could not make it there yesterday. I honestly thought that it really wouldn't be much of a deal as I'm only on 80ml and have been taking my dose since February of last year as well as been stabilized on this dose for the last nine months or so. I had taken my dose on Tuesday at approx 1pm and figured that I would be fine until this morning at 10am.

I got through the majority of yesterday without incident. Work was fine. I noticed in the afternoon that my stomach was unusually unsettled and that I had a few uncontrollable sneezing bouts, but I simply put this down to picking something up from the kids, as Sara had been complaining since the weekend of being really congested, plus having a sore throat. By about ten last night though I started to really feel like crap.

My stomach was still unsettled and my nose was running constantly, plus my body started to ache all over and my head was pounding. Great, I thought. As it had been what seemed like a near eternity since I had been dopesick, I'd allowed myself to become somewhat cavalier about the whole thing. How soon, and easily, we (can) forget. As there wasn't really a whole lot that I could do at this point, I basically decided that probably the best thing for me to do was to try to sleep through this whole ordeal, so that when I woke up in the morning, the first thing I'd do was drag my sorry ass to the clinic.

It has now been an hour and twenty minutes since I took my methadone and miracle of miracles, I feel just fine. My stomach is no longer bothering me, although now I feel absolutely ravenous, plus I've stopped sneezing and my nose is no longer running. Soon I imagine, the last of my body's aches will also disappear.

Obviously this illustrates what a powerful tool methadone can be in our fight against addiction. It sure is no lightweight. And yes, this also illustrates how addictive the solution to the problem can be and how yes, we may just be trading one evil for another with no great improvement ultimately in our "prison sentence". So what's an addict to do?

For me personally, I know that MMT is the best solution. Where I live, suboxone has not yet been approved so it can not yet be legally prescribed. Cold turkey is for the birds, literally! A decade ago, I spent just over two years on MMT and was able to stop it by gradually tapering down my dose. Once I had reached about 15ml, I just stopped taking it and except for about seven to ten days of mild discomfort, I didn't suffer much at all. All of my cravings by this point had also been eliminated. For another three years, I continued to remain opiate - and methadone - free. Going back to them is a story for another day.

Obviously I'm not yet in a comfortable enough place to even consider weaning myself off of this treatment but I also know that I'm not necessarily condemned to a life sentence although, if worse came to worse and I was, I'd eventually find a way to deal. Right now, all that I know is that I don't ever want to feel even remotely dopesick again if I don't have to.

I'll not be so cavalier in the future either, because at the end of the day, its also bigger than simply feeling dopesick. Obviously, my mood would end up affecting my family and my work, and not in a positive way. I've made far too much progress in the past year and a half anyway to mess it up. I'm also glad that I rode out the sickness rather than taking the easy way out by medicating with some other type of opiate. Let me tell you that around 4:30am this was a real possibility that I'm glad I didn't follow through with.

Dave Gahan - KINGDOM

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Tuesday, September 25, 2007

Angel of the Morning

All things considering. my teenage daughter and I have a fairly fantastic relationship. I trust her judgment for the most part and feel that she is quite mature for her age. I respect most of her decisions and do my best to be supportive of her endeavors. There certainly have been times when I’ve had unilaterally veto one of her plans but this is the exception rather than the rule.

Now all of this being said, sometimes I find her behavior is more than enough to drive me completely, absolutely certifiably insane. It always seems like it is the little things that end up pushing me over the edge also. Yesterday evening and today would be classic Sara - and Katie - stuff. Before they were able to do anything yesterday, they had to pick up the massive pile of clothes that had been growing on their bedroom floor for the past week and a half. Combined with the clothes was an odd assortment of other crap, so much so that one could no longer see their carpet. I felt that this was a more than reasonable request.

Journals

I have been keeping a journal of some sort on and off since I was about 11, so about 32 years now. I kept one religiously all thru high school and university because it seemed like so much was happening and things were changing so quickly that I was afraid that I would forget stuff and I wanted to remember everything, good or bad. As I settled down into married life in my twenties and then motherhood in my thirties, keeping a journal was the farthest thing from my mind. There just didn't seem to be the time and if seemed as if life had settled into somewhat of a routine. Excitement and change seemed to be a thing of the past. Not that this was necessarily a bad thing, just different.

Five years ago this past June, my father was diagnosed with cancer and he passed away the following March. Towards the end of his life, I picked up pen and put it back to paper in a large part to work thru my emotions while my father was dying and because I was afraid that I might forget something about his last days. Also my writing became a relief in many ways for my mother who was afraid that she would forget some minute detail of my father's final days. It suddenly became extremely important to her that I was able to recite in great detail everything that might have occurred on a specific day or over a specific time period. My journal became her security blanket in many ways. It was definitely a time of change for all of us.

After he passed, I continued to write as an outlet for my emotions. I carry my journal with me everywhere and any time I feel the need, I write something in it. An entry can range anywhere from one word to endless pages. I have found that whenever I am restless, upset, bored, impatient, irritated, you name it, the moment that I start writing I am immediately calmed. Needless to say, my recent journals follow no set form. They range from neat and tidy to tremendously disorganized and messy. I paste pictures in them sometimes. I doodle in them. I make sure that each one is different from the next. I haunt stores looking for unique and different books to use as journals. I have made them all my very own by decorating them in some special way covering many of them in scraps of expensive taffeta and similar fabrics.

About three and a half years ago I was told about livejournal.com. This was my first foray into online journaling. It took me a long time to feel comfortable expressing myself publically, but once I got the hang of it, it became easier and easier. I have liked using livejournal and in fact now have a number of accounts there. Mostly I use them to display and store my art work or to join one of their many communities that have interested me in the past. At first I really liked having my journals there and especially liked the whole "community" mentality but after a bit of time there, I started to want or need something different. I started looking for alternate places where I might be able to share my alternate life, something I had yet to be honest with at livejournal.com.

I also wanted my journal to actually reflect what was really going on in my life but because of my "alternate" life I found that this was near impossible using the identity I had been using, well mine. One day I created an alternate online identity to reflect my alternate life. No one would know that it was me. Hence sickgirl was born, a name that I got from bastardizing a Social Distortion song Sickboy plus the whole addict world of dope sickness.

I've now frequented various places on the net as sickgirl now since about the fall of 2004 so I guess its been about three years now. I'm still not completely honest with the world as for all intents and purposes I'm blogging anonymously but then I guess lots of us are doing just that too. While it would be ideal to be able to be completely forthcoming, I know that this would be impossible because there are other people than myself involved in this endeavour and it wouldn't be fair to them.

Saturday, September 22, 2007

Monday, September 10, 2007

A Day Late...

I wish that I had a bit more time right now to spend updating my journal but am buried alive in paperwork at the moment and until I've got all of it even semi organized, I really can't spare too much time for recreational pleasures. I imagine, though, that by the end of the week, I should be all caught up and if everyone around here is correct, September and May are the two stupidly busy months for rental properties that its all smooth sailing from now through the next eight months. Apparently we've survived the absolute worst and have been told that by next week, we won't know what has hit us as we'll suddenly have loads of spare time on our hands.

Sounds simply marvelous to me. Our training period is more or less complete now also. We both feel more than comfortable in our new positions as well as working within the confines of this company, our employer. For September, we had nineteen units vacate plus twenty one move in. This was all done over a five day period for the most part too, which meant a near week of sleepless nights as the units that were vacating had to be made ready for the new tenants. Now by made ready I mean that they all had to be painted, carpets steam cleaned or replaced plus the unit had to be thoroughly cleaned. They all had to be made to appear brand spanking new just like a virgin!

Now I've just got to tidy up all of the paperwork related to the new tenants and address some minor issues here and there from some of the units and I'll be all done. Sweet. Can't wait to be able to really sit down to my computer and get caught up with all of the journals that I read as well as make this one a little bit more current. Looks like I'll have loads of time soon as for October I've just got two units to worry about - not twenty one!

Sunday, September 02, 2007

Mary Jane Meets Charlie And They Are Never The Same Again...

Most of this entry was written over two years ago but feel that it is pretty relevant to the present day as most of you don't yet know me and many don't often have the time to wade through each and every journal's archives. Figured that now was a good a time as any to share with you some of my history! My weakness is and always has been anything that is part of the opioid family. Up until that first hit, I had been somewhat indifferent towards drugs but the moment that first dilaudid entered my system, I knew that it was pretty much all over for me. I had found my Achilles heal although at that time, I had no idea what a roller coaster ride I was about to begin.

I actually never even tried drugs until I was almost twenty-one. Through high school, I was more of a drinker. My brother who is a couple of years younger than I am began experimenting at the ripe age of 12 and I watched in absolute terror what he was doing and did to his young body. I also did not want to add to the anguish that my parents endured as my brother navigated thru his teen years. I just couldn't added to that so I kind of made a casual commitment to myself that I could wait to try plus in all honesty, it didn't look like a whole lot of fun watching my brother puke, stagger, dribble down his clothes, pass out, you name it. I can't remember how many times my boyfriend or myself or both rescued my brother from mess after mess after mess. Believe me nothing about his behavior was remotely attractive and as a result I never felt as if I missed out on anything. Now in hindsight I am kind of glad that I never used anything as a teenager because my brain cells were pretty much left untouched during their crucial growth period.

For my first year of university there were no situations that I found myself in to have a chance to try anything other than liquor. Again never felt as if I was missing anything. Finally in my second year, I decided that I wasn't going to lifeguard. Instead, I wanted to give waitressing a try because I felt I had a greater chance of making much more money while working less hours. I found a place to hire me as a cocktail server and this place just happened to be the place to go every Thursday, Friday and Saturday way back then. I made money hand over fist and I started meeting some very interesting and experienced people - both fellow staff members and customers. Lord when I think back to my second year, I was so utterly out of my depth and so very green. I started going to the parties after the bars closed and finally I was standing around with a group when someone passed a joint around. I carefully watched everyone and when it was my turn, I believe that I carried it off like a pro. Once people had seen me take some form, any form, they became much more open and inviting with me.

The next party I find myself being invited into one of the three bedrooms with a couple of other people. When I get in there, there are about a dozen lines of this white powder lined up in a row and a guy sitting behind the table. He says help yourself to us with the qualification that it will cost us $10 a line. I had never seen cocaine until that moment and to be honest, I didn't really have any idea what it actually was and what it would do...Drum roll...Of course, I ponied up my money and waited my turn. Again I paid close attention to what the others before me did and when it was my turn, I flipped my hair over my shoulder so that it fell down my back out of the way of this precious powder. Inhale and away I went. It was the coolest. Oh my goodness, I felt amazing. I was amazing. I was no longer little shy me from no name town population 1500. I had arrived and what an arrival it was!!!

My second year at university was coming to an end and I was getting ready to spend the summer in the British Isles with my best friend. About a month before we were to leave, I got involved with one of the bouncers at work. He was a very bad boy and I found him so utterly exciting. He just oozed danger and I was ripe for the picking...

TO BE CONTINUED...MUSHROOMS, ACID AND THE RINGING IN MY EARS

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