relapse triggers – Opiate Nation

The Importance of Friends – Part 1

(Translation into most language at tab to the right.)

Approaching what would be my son’s 36^th birthday, I thought about the last year of his life. I don’t think about it often because it is painful – so many wishes that things had gone differently for him.

One sadness is that when in active addiction, he was very alone. It’s not that JL didn’t have lots of friends – he did. He was friendly and likeable and the large group of friends who came to his memorial is a testament to that. But most of his high school and university-era friends were not involved in his life during the last few years of his life, and the last year in particular. After his accidental fall and relapse to opiates in 2008 and the next seven years in and out of recovery programs, his life became narrower and something he was ashamed of.

An event that stands out was during a time of heroin use that we were not fully aware of as he lived in our rental house, and we thought he was attending his classes at university. We received an urgent call from two of his friends telling us that they knew he was back to spending all his time with his friend that used heroin with him and they were not getting an answer to their calls. They were at his house and he wasn’t responding to their knocks on his door – did they have our permission to break his door down? Our frightened response was “Yes!” They found him deep in drugged sleep and alive but very startled when they burst in. They confronted him with what they knew and their concern about his drug use. He of course was defensive and pretended that nothing was wrong.

Gradually, these friends, along with others, were no longer part of his life. JL did make a good friend or two in his recovery programs, but he always kept his addicted friends and dealers separate from his sober friends who were mostly not aware of his use and relapses – he had a pretty good poker face. Most of them were shocked to hear of his overdose death because he had been in a sober living house for six months and doing well.

Many of the friends who had such good times together when JL was clean (although not necessarily sober, as they enjoyed drinking with him not realizing how that always led back to drugs for JL) felt guilt after his death. Guilt because he called several of them the week before his death when he had just relapsed. It seems he wanted a friend to talk to and perhaps perceive that he was struggling. And guilt because they wished they had stayed in touch with JL and not distanced themselves from him when he continued to struggle with addiction.

But there’s the rub: How do sober friends stay involved with a friend who is in active addiction? I think it is especially difficult for young people, who don’t know what they can do, who may be more concerned with their own lives and issues, and who are not yet mature. This is not to suggest that any human is ever totally selfless regardless of how old we are – I know myself too well to hold this delusion. But the passing of years does bring relational experience and can help us focus more on those around us.

Next month I will try to share some insights and ideas for teens and young adults for how to truly be a friend to someone who is struggling with addiction and sobriety. Just remember:

Don’t ever give up on your friends or family who are trapped in addiction. They need good friends more than ever. King Solomon gave this wise insight 3,000 years ago: Two are better than one, because they have a good return for their labor: If either of them falls down, one can help the other up. But pity anyone who falls and has no one to help them up. (1)

Many people will walk in and out of your life,

but only true friends will leave footprints in your heart.

—Eleanor Roosevelt

Ecclesiastes 4:9-10

Loneliness in a Lonely Time

It has been said that the opposite of addiction is not sobriety, it is connection – to others, to a community. The Coronavirus pandemic has brought disconnection and magnified loneliness and stress for people the world over due to social isolation, economic instability, reduced access to spiritual communities, and overall national anxiety and fear of the future. “We certainly have data from years of multiple studies showing that social isolation and social stress plays a significant role in relapse…and relapsing to drug use can play a role in overdose.” Dr. Wilson Compton, deputy director NIDA.

The acronym HALT: Hungry, Angry, Lonely, Tired, is used in Alcoholics Anonymous and most recovery programs. It is a simple reminder that when our basic human needs are not met, one is susceptible to toxic thoughts and self-destructive behaviors including relapse and suicide.

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.