Triggers

A young friend visited our blog this week and had a very disturbing experience. She is a recovering IV drug user and someone I rely upon for  honest input and opinions on drug addiction and recovery. She is one of the few opioid addicts we know who has survived to have a second chance at life.

When she saw the image of a needle in a spoon she said: “I absolutely can’t handle that kind of trigger. For the families of users and people in recovery, that image is especially traumatic. It would make my parents panic, and it made me panic also.”

I felt so unwise – and sorry. I thought back to why I had used that photo. It was one we found on our son’s phone months after he died – I was stunned when I saw it and found that he had taken it two weeks before he died. The fact that he took that photo, documenting his using, was so distressing to us – I felt he did it to urge himself to get help but just couldn’t. 

I wanted the photo to convey the reality of what we, as families of addicts, face in our daily lives. But, as another young recovering addict friend said: “It’s like having a graphic image of someone on their death bed being injected with chemo – and trying to use that for an article about cancer. It adds shock value, but not too much else.”

So what are triggers? Are they the same for everyone? Our son said it was not hard for him to be around us when we were drinking alcohol – it was his decision to drink or not. But that was not what actually happened when he was around friends and alcohol – he ended up drinking – and then relapsed on drugs. We don’t know what the other triggers were for him with opioids, but when an addict sees things that they associate with drugs and their own using, it causes intense cravings, memory flashbacks, PTSD symptoms, racing heart, panic – and ultimately a step towards finding and using their drug of choice.

There are many good articles on internal and external triggers for addicts and alcoholics. I will summarize a few important points from this article, well worth reading: Understanding Triggers

by Sonia Tagliareni  https://www.drugrehab.com/recovery/triggers/

Long-term drug use creates an association in the brain between daily routines and drug experiences. Individuals may suffer from uncontrollable drug or alcohol cravings when exposed to certain cues. The cravings act as a reflex to external or internal triggers, and this response can even affect individuals who have abstained from drugs or alcohol for a long time.

External triggers: are people, places, activities and objects that elicit thoughts or cravings associated with substance use…A NIDA study maintains that exposure to drug-related objects may influence a former addict’s behavior. The brain registers these stimuli and processes them in the same areas involved in drug-seeking behavior.

Internal triggers: are more challenging to manage than external triggers. They involve feelings, thoughts or emotions formerly associated with substance abuse. 

Stress: stress rendered people in recovery more vulnerable to other relapse triggers.

Another good article:

https://www.thefix.com/content/triggers-addiction-dawn-roberts0318

I am grateful for the feedback from our young friends. Reviewing the role of triggers has been an important reminder that there are many friends and strangers who need me to be more thoughtful about what they are struggling with on a daily basis and to take the time to find out what I can do – or should not do – to support their recovery efforts.

The Hijacked Brain

I watched an interview on the PBS Newshour the other night with a physician whose young son recently died of a heroin overdose. He has started a foundation to help raise awareness and to bring an end to this deadly epidemic. My husband and I connected with him on so many levels: having a wonderful and brilliant son – who desperately wanted to be free of his addiction – die a needless death; the remorse over not knowing what we could have done differently to help our son; the desire to do something to help others before they are forced to share our pain and grief. In the interview he reiterated the truth that few people understand about opioid addiction: once a person is addicted to opioids, they are truly not normal or themselves any more. The drug has hijacked their brain and they are not capable of thinking normally. They must have the drug at any cost.

This is the reason that there are so few opioid addicts who live long enough to enjoy recovery, as opposed to addicts who use uppers like cocaine or meth. As Tracey Helton Mitchell said in her memoir, The Big Fix: “Heroin kept me chasing my tail, but crack (cocaine) finally sent me into recovery.” Our son’s addiction doctor put it this way: “Most people will build up tolerance to opioids and that tolerance is what leads to addiction. Once addicted, it is only over a long period of time with medication and group therapy (like the 12-Steps) that a person has hope of being free. This is why I call it the cancer of brain diseases’.”

In her article in The Washington Post, December 1st, Dr. Sandra Block (a neurologist) gives further evidence as seen on EEG’s on the changes to the brain that opioids cause:

“Neurologically speaking, opioids are crafty. They turn the brain’s own electricity against it, rewiring connections in an endless feedback loop for more drugs. They trick the brain into a death trap, as users chase the chemical bliss from the drugs with more drugs. Acute opioid usage (that is, the high itself) translates into slowing on the EEG. Usually, such an effect is transient, carefully monitored by an anesthesiologist during surgery, for instance. But when the patient becomes the anesthesiologist, the cycle can become lethal…the opioids overwhelm the brain’s respiratory center, causing cardiac arrest… I’m seeing brain death in people who haven’t lived their lives yet, whose brains haven’t even fully developed, brains that are literally killing themselves for drugs.”

My goal in sharing this information is that it will bring awareness to families and friends – and addicts – about why opioids are so pernicious and that we will begin to see those trapped in the addictive spell as individuals who really do want help. Learning what actual help is, as opposed to enabling the addiction, is a topic for another time.