In yesterday’s blog post, I presented the first half of an article I wrote back in 2021 for my eBook Our Recovery Stories: Journeys From Drug and Alcohol Addiction and my Recovery Stories website. Here is the remainder of the article. You can see a link to a pdf version of the full article below. Please pass this article to as many friends and colleagues as possible.
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8. Understanding
Understanding is essential for recovery. People with substance use problems and those on a recovery journey need information and education about a variety of matters, including: the nature of addiction and their own substance use problems; the range of interventions they can use to help them manage or overcome these problems; opportunities that allow them to exercise their strengths and assets; supports they can use to facilitate their recovery journey, and self-management skills that help them cope with situations that might lead to relapse.
Recovering people are a major source of information that can facilitate another person’s recovery journey.
People with substance use problems and those on a recovery journey need to understand that addiction is generally a symptom of a deeper underlying problem. The recovery process is greatly facilitated by tackling the underlying problem. World leading experts like Gabor Maté and Bessel van der Kolk see addiction arising from past traumatic experiences. Gabor Maté stresses that whilst addiction is a problem:
… it is also an attempt to solve a graver problem that is, unbearable psychic pain. To understand addiction we need to understand human pain and that takes us to focus on childhood experiences.
People who have been traumatised often don’t fully understand what is going on for them and often don’t look towards other people for help.
Trauma builds into us feelings of worthlessness and self-destructive urges. We experience people as being inherently untrustworthy, so when we have problems, we don’t reach out for help, instead relying on the comfort of a liquid. Deep down, we feel that a lethal painkiller is all we deserve to soothe us.
The prevalence of trauma had been apparent in my experience of working with addicts. I had seen myself as an outlier. I now understand that I had just as traumatic a childhood as most addicts did. I just didn’t know it.’ Beth
Some people deal with the psychological pain caused by past traumas by going to their GP, where they may be prescribed a benzodiazepine drug such as Valium. This class of drugs is highly addictive. Other people drink alcohol excessively, while others turn to the ‘street’ to obtain and use heroin. This drug alleviates both physical and psychological pain.
A person who has been traumatised by physical, sexual or psychological abuse as a child will not only feel the powerful analgesic effects of heroin, but may also benefit from relationships and experiences within the social setting in which they take the drug. The people who they take the drug with may have experienced similar abuse in their youth, or may know others with similar problems, and are therefore more likely to be understanding and comforting.
At least three of the stories in Our Recovery Stories project refer to traumas experienced as a child. Natalie did not realise until many years into her recovery, when she attended a talk given during a session of the Sycamore Tree Project run in a local prison, that she had been traumatised by her experiences as a child. Once she started to address this trauma, and the issues that had arisen following her visit to the prison, Natalie found a ‘new level’ of recovery.
I now feel happier and more content when I go back and explore the past. I don’t feel the shame to the same level that I used to feel. I can look back at it and take it as it was. I can feel what it must have been like for my Dad, how awful it was for him, without being overwhelmed by negative emotions relating to this or to what I experienced. I can think clearly about the positive things my Dad did, like the advocacy work he did for fellow prisoners.’ Natalie
A variety of models of addiction have been proposed, the best known being the disease model of addiction. This model has caused controversy, the details of which I am not going to describe here. What is important in terms of a person’s recovery is for them to gain an understanding of their problem—their addiction, and the factors that have contributed to its development and maintenance—and how it can be overcome, the factors that facilitate recovery.
A person may believe in the disease model because it gives them an explanation for why they are as they are. It may help them to stop blaming themselves for their destructive behaviours, which can facilitate recovery. However, any other model, or combination of models, as an explanatory framework might be beneficial. The most important thing is that the person must understand and relate to the model—it must be believable and ‘actionable’ to them. Of course, a person may change opinions about different models at different stages of their addiction journey.
People on a recovery journey generally learn a lot about themselves during this journey, a process that is often facilitated by other recovering people.
I learnt in group that I am not a bad or an evil person. I learnt that I can’t be perfect and I make mistakes. I learnt that I don’t know everything and that I have a lot to learn. I learnt that I am willing to learn. I discovered that expressing my emotions was healthy, even though everything within me said otherwise…
… This was probably the first time that I realised that my addiction wasn’t about a particular substance, but was about my way of thinking or perception of reality. The substance was in fact my solution to my inability to live at peace with myself. Coming to accept that I, rather than the substance, was the problem, was the foundation to my recovery. The realisation that, ‘If I worked on myself, I wouldn’t need to keep running to chemicals’, was a revelation.’ Paul
‘I’d arrived at this point in my life with some really embedded behaviours that I was coming to understand were not just fear-based, but almost completely self-defeating. As a self-absorbed, self-centred person, I was used to the idea that I was always right, and that nothing was my fault. As a newer member of NA, I was learning that it was not possible to resolve these conditions alone. I was now responsible for the direction of my life, but I needed external guidance. There was a wealth of experience for me to draw upon, not least within my own community.’ Simon
Sometimes, a new insight or understanding can have a profound effect on someone trying to recover from addiction. Brad decided it was time to take a break from drinking. He abstained for six weeks, but found that his craving for alcohol was stronger than it had ever been. He couldn’t understand why.
Alan, who was 16 years in recovery, simply said to me, ‘Brad, you haven’t just got a problem with alcohol.’
When he said this, I thought to myself, ‘He’s mad. What does he mean?’
He then proceeded to tell me that if my problem was just about alcohol, then everything in my life would have been rosy and nice when I had stopped drinking. Clearly, this wasn’t the case—everything wasn’t as perfect as I had expected.
At this point, I experienced something I remember clearly like it was yesterday. My head span and I was dizzy. I had never realised that my problems involved more than just alcohol—they involved me as a person. No one had explained this to me before. Alan also said to me that if I were to listen to him, then this would ‘fuck my drinking up’. It certainly did that.’ Brad
Anna’s life became focused on her brother’s addiction to heroin. She decided to go to a psychologist.
In the third session, the psychologist said to me, ‘Anna, I’ve been hearing a lot about your brother and all of his problems. What about you? Do you think you might have a problem with drugs too?’
I said, ‘Yes.’ I was drinking every night to cope with what was going on, and my boyfriend at the time was also a heavy drinker. She said that I needed to accept that I couldn’t change my brother’s behaviour or anyone else’s. I could only change my own. She also said that I needed to focus on my own life, and stop focussing so much on my brother’s.
After the session finished, I went out to my car and bawled my eyes out. However, this was a different type of emotional release. I felt an overwhelming sense of relief. I knew that things would be different for me, and that I could change the way I was thinking and feeling.’ Anna
Many people with a serious substance use problem start using drugs, alcohol and solvents during their early teenage years, at a time when they are still developing emotionally. This substance use, particularly if it gets out of hand, can interrupt their emotional development, such that their emotions, thinking and behaviours are influenced in a negative manner in later life. They can act as if they are still in their teenage years and be unable to deal with situations that someone with a normal emotional development would deal with.
And even today, I’m puzzled a bit by what was going on in my head. But I think it comes down to the fact that I never had the emotional development that other people had as child and a teenager, because I was sniffing glue and other substances and then drinking excessively. Over the previous years of my recovery, I had been learning slowly to deal with new emotions. The more I dealt with them, the more used to them I became. However, I had never experienced anything like these feelings of love. They hit me like a ton of bricks and I had no idea how to deal with them.
Rather than work through the emotions, I told myself I couldn’t do it. I didn’t use my anaesthetic (alcohol), since I didn’t want to drink. I decided to just run from the situation. I went home, switched off and blocked everything out. I didn’t contact Emma. It was all just too hard.’ Brad
9. Overcoming stigma
Stigma can be defined as social disapproval of personal characteristics, actions or beliefs that go against the cultural norm. It can occur at a variety of levels in society, i.e. individuals, groups, organisations and systems. A person can be labelled by their problem (e.g. addiction to drugs and/or alcohol) and they are no longer seen as an individual, but as part of a stereotyped group, e.g. a ‘junkie’, ‘alkie’, etc. Negative attitudes and beliefs toward this group create prejudice which leads to negative actions and discrimination.
For example, people addicted to heroin are often considered to be carriers of hepatitis C and other blood-borne viruses, thieves who rob old ladies of their handbags, and dirty, weak-willed junkies who will never get over their problems. ‘Once a junkie, always a junkie’ is a saying I’ve even heard in discussions amongst drug treatment agency workers. Our Wired In research has not only shown the strong prejudice that exists towards heroin users, but also towards recovering heroin addicts.
Stigma can impact on a person with a substance use problem, or someone on a recovery journey, in various ways. It can create feelings of shame, blame, self-disgust, self-hatred and hopelessness, and impact badly on self-esteem and self-efficacy. The person may isolate themselves, or remain in the drug-using community for fear of being judged and treated badly by other so-called ‘normal’ people. They may decide to avoid looking for help for the same reasons. External stigma has become internal stigma—both forms of stigma are barriers to recovery.
Family members are also affected by stigma, in the sense that they are fearful of being blamed or held responsible for their family member’s addiction, or they are upset by the way that their family member is treated by other members of society.
The worst thing for me was the attitudes of some of my work colleagues. It’s very strange because I work in a caring profession in the health service, but some of the attitudes of workers were truly awful. Over the time that Kevin was an inpatient, I heard that the staff had been gossiping about him, not only on their ward but on other wards. They discussed Kevin and our whole family in a very derogatory manner. Much of what they said was unfounded or damn right untrue. I find it incredible that they can break confidentiality with other members of staff.
I was angry and hurt and felt dreadfully bad for Kevin. He was desperately ill and they were discussing him in such a malevolent way. Gossiping, saying, “Why hasn’t his father visited?’, or ‘His sister has cut him off?”, which was quite untrue at that time….
… People are really unaware of the deeper issues surrounding addiction. I would have thought the people I was close to at work would have understood. Yet all they could say was, ‘She should cut him out of her life.’ I actually had someone say that to me, not in a nasty way, but thinking that she was being helpful. I took it as well-intentioned, because she wasn’t malicious, but I said, ‘There’s no way I could do that, he’s my son.’ Kerry
Society needs to change in order to help more people recover from addiction. People who have recovered, or are receiving from serious substance use problems, can become advocates and contribute by helping communities transform into environments that are more accepting of people who have developed substance use problems, and ensure that treatment and other support services eradicate stigma and discrimination towards people who are trying to recover from their problems. Such advocacy can facilitate personal recovery, as well as indirectly facilitate recovery in others.
I believe that if there wasn’t such a massive stigma attached to addiction, then more people would be inclined to seek help. As it is, a lot of addicts wait until they hit a rock bottom or two, before they finally get so desperate that they have no choice but to ask for assistance.
As a society, we need to foster an environment of sympathy and support, rather than judgement and blame, in order that people are able to ask for help sooner. We should encourage people rather than sanction them for admitting they have a problem. Addicts should not have to wait until they have lost everything, including any self-esteem they once had, and are so desperately mired in shame that death or recovery are the only options.
We also need more role models who are prepared to stand up publicly and show that they are not ashamed of being recovering addicts, because there is nothing to be ashamed about. I only understand as much as I do about addiction because others were prepared to share their knowledge with me. I only knew that recovery was possible, and desirable, because of examples of other alcoholics who had found recovery. But we need to bring that message out of the dimly-lit church halls and into the open for everyone to see. It shouldn’t be hidden away, obscure and hard to access. The message should be loud and clear, so that it is accessible to everyone.’ Beth
In saying this, it must be recognised that some recovering people prefer less visible, direct, or explicit ways of dealing with stigma, such as ‘passing for normal’, only confessing current or past problems to people they trust. Some of these people may avoid professional treatment because they have experienced prejudice, or feel they have been judged negatively, in such services, and turn to peer support groups. Recovering addicts are far less likely to be judgemental and prejudiced.
Ultimately, each individual will find what suits them best during their recovery journey. What is important is that the person feels good about themselves and proud of what they have achieved. They must find places in the community that allow them to feel in this way. They must have role models. They must learn ways to overcome the negative attitudes of others. They must know when they deserve better and stand up for themselves when they are being mistreated.
I leave this section with the words of Gabor Maté from his book In the Realm of Hungry Ghosts [1]:
Addicts are locked into addiction not only by their painful past and distressing present but equally by their bleak view of the future as well. They cannot envision the real possibility of sobriety, of a life governed by values rather than by immediate survival needs and by desperation to escape physical and mental suffering. They are unable to develop compassion towards themselves and their bodies while they are regarded as outcasts, hunted as enemies, and treated like human refuse.
10. Gaining a positive sense of self (or positive identity)
People with serious substance use problems lose a lot of the roles or personal characteristics that help define their normal identity (e.g. loving son, athlete, generosity, intelligence) as their dependence on their substance(s) increases, relationships wither and isolation increases. Eventually, their identity as viewed by others may become ‘a useless, dirty addict’. They will also have personal views of what they have become and these views can lead to lowered self-esteem or even intense hatred of oneself.
On the basis of qualitative research with over 100 heroin addicts who had recovered from their addiction without professional treatment, Patrick Biernacki argued that:
To change their lives successfully, addicts must fashion new identities, perspectives and social world involvements wherein the addict identity is excluded or dramatically depreciated. [2]
James McIntosh and Neil McKeganey (2002) came to the same conclusion, on the basis of their qualitative research with 70 people recovering from drug addiction, most of whom had received formal addiction treatment at some stage [3].
… at the heart of most successful decisions to exit drug misuse is the recognition by individuals that their identities have been seriously damaged by their addiction and the lifestyle that accompanies it. This, in turn, stimulates a desire to restore their identities and to establish a different kind of future for themselves.
These Scottish researchers argued that successful decisions to stop using illegal drugs come from (1) a motivation to ‘exit’ use which is more powerful than the fear of stopping, and (2) a sense of a future that is potentially different from the present. This successful decision may come from rational decisions, arising from the person wanting to stop using on the basis of the unacceptable nature of what they have become, or from ‘rock bottom’ decisions. With the latter, the person knows they have no other viable option but to stop. They have reached the end of their tether. Often the person has contemplated, or even attempted, suicide.
The transition to non-addict status is by no means an easy one, since it generally involves a major disruption to the person’s life.
All of a sudden, the social networks, values, activities and relationships that had defined and structured the addict’s life are removed and a potential void is created…. it is essential that this gap is filled in an appropriate and constructive manner if the individual is to stand any chances of success in sustaining his or her recovery. In addition, of course, a new non-addict identity also has to be constructed and sustained. None of this happens on its own. It has to be managed by the addicts themselves and often at a time when they are not feeling particularly robust.
Two main strategies that the people in this study used to achieve their goals were (1) the avoidance of their former drug-using network, and (2) the development of a set of non-drug-related activities and relationships. The alternative lifestyle which these relationships and activities provide, give the person an enhanced sense of personal value and a new meaning and purpose to their life, and imbue them with a sense of hope for the future.
Paid employment was especially beneficial; it occupied their time constructively, did wonders for their self-esteem and provided a network which could assist in the validation of their new identities. Relationships with non-users were also central to the recovery process; these people provided the necessary social acceptance for the recovering addicts’ new status and made it possible for them to participate in the drug-free world. They also provided companionship, which played an important part in preventing loneliness and isolation, thereby neutralising the latter’s potential to draw the recovering addicts back into the company of users.
Patrick Biernacki discusses the transition that the recovering addict makes into the so-called ‘normal’ world, providing an indication of how ‘normal’ people can facilitate or hinder a person’s recovery journey [2].
Those addicts wishing to change their identities may first have to overcome the fear and suspicions of nonaddicts before they will accepted and responded to in ways that will confirm their new status. Gaining the recognition and acceptance of the nonaddict world often is a long and arduous process.
Eventually, acceptance may be gained by the exaddicts behaving in conventionally expected ways. Following “normal” pursuits, remaining gainfully employed, meeting social obligations, and possessing some material things will often enable nonaddicts to trust the abstainer and, over time, to accept him and respond to him in “ordinary” ways.
At the same time, the addict’s feelings of uncertainty and doubt will lessen as he comes more fully to accept the new, nonaddict life.
As the process of recovery unfolds, the person starts to regain elements of their old identity and/or elements of a new identity. These changes operate at both an external level (what others perceive of you) and internal level (what you think about yourself).
Interestingly, many people in long-term recovery (and others around them) comment on their becoming a better person for having gone through the recovery process. This is not surprising, given the intense and painful journey that recovering people have taken and the great deal of self-analysis that has generally been undertaken.
11. Overcoming withdrawal symptoms
People who decide to stop taking drugs or drinking alcohol after using or drinking for long periods of time, need to be aware that they might experience withdrawal effects which can be irritating, debilitating and even life-threatening. Many of these withdrawal signs, which can be psychological and physical in nature, are generally opposite to the effects the person experienced when the drug was being taken.
For example, abrupt withdrawal from long-term use of Valium (diazepam) and other benzodiazepines, drugs which are prescribed to alleviate anxiety and insomnia, can lead to pronounced anxiety, insomnia, agitation, intrusive thoughts and panic attacks. In addition, people withdrawing from benzodiazepines can experience physical withdrawal signs, such as burning sensations, feeling of electric shocks, and full-blown seizures. The duration and strength of these withdrawal signs is dependent on the amounts of drug having been used and the duration of time the person has been using the drug.
Long-term administration of drugs and/or drinking alcohol can lead to tolerance, such that over time higher doses of the drug or alcohol are required to exert the same positive effects seen initially with the lower dose. One consequence of this tolerance is that increasing the dose over time is likely to lead to more pronounced withdrawal signs when drug or alcohol use is terminated.
People wishing to terminate use of benzodiazepines after long-term administration should seek medical advice, for example from their GP, before doing so.
The detox from Benzos was one of the worst things I have ever been through. I continued being reduced by 1mg a week until I got to 2mg a day of diazepam, and then my GP stopped the script. I have since found out that this wasn’t really the best thing, for my mind or body, to be stopped cold turkey still on 2mg a day. I had some seizures and terrible headaches, and I couldn’t sleep properly for months. The first time I had a seizure I was out in town and knocked myself out on a wall. I was taken to hospital where they gave me some diazepam, as they were sure that the seizures were from the doctor reducing me too quickly.
I ended up in hospital about nine times with seizures, but I would not take more benzos, since I didn’t want to go through the withdrawal again. I was worried that I would feel awful forever, and never escape from my addiction, but after about eight months it seemed that the worst of the withdrawals was over.
Once the seizures were under control, helped along by some non-addictive epilepsy medication, I tried to get back to a normal day-to-day life. However, I was so nervous about literally anything and everything. I found it difficult to learn how to deal with anxiety and stress without having benzos to help. I thought I would never lead a normal life. It took almost a year after the detox before the anxiety and sleeplessness had subsided to a manageable level, so it was difficult to plan anything for the future as my head was all over the place.’ Sapphire
People who have become heavily dependent on alcohol may need to seek medical advice before stopping drinking. Alcohol has some similar actions to benzodiazepines in the brain, and similar withdrawal symptoms, such as increased anxiety, agitation, intrusive thoughts and even seizures.
People who have become addicted to stimulant drugs like amphetamine and cocaine can feel depressed when they stop using. The expression ‘What goes up, must come down’, comes to mind. Heroin withdrawal signs include stomach cramps, vomiting and retching, muscle pains, the shakes, hot and cold spells, and headaches. The strength and impact of these withdrawal signs depends on the length of time using, doses used, and the overall physical condition of the user. Withdrawing from stimulant or opiate use is rarely life threatening.
However, a person who has stopped using heroin—from being in prison, for example—and then decides to use again must be very careful. They must inject less drug than they had generally used before terminating use, as their tolerance has been lost due to the period ‘away’ from the drug. Too my people have overdosed, due to respiratory arrest following injection of their ‘usual’ dose, by ignoring this piece of advice.
Craving, an intense or overpowering desire to engage in drug-taking or alcohol consumption, can occur for substances associated with addiction, such as opiates, stimulants, alcohol and nicotine. Craving has been suggested as a prominent feature maintaining drug/alcohol use and precipitating relapse after a period of abstinence.
Craving can be produced by external stimuli and/or internal mood states. Over a long history of drinking or drug-taking, stimuli that have been repeatedly associated with consumption of alcohol or drugs (e.g. sight of the pub, or the syringe) become conditioned stimuli that can elicit craving. For example, watching someone smoke a cigarette and the smell of the tobacco can remind an ex-smoker of the relaxing effect of smoking and trigger an intense desire to experience this effect again.
Craving can also arise from the need to relieve withdrawal or conditioned withdrawal symptoms. Thus, a person returning to an area where they have experienced withdrawal on many occasions in the past may experience conditioned withdrawal symptoms, which in turn can generate craving.
Mood states also elicit craving. Many of us have needed a drink of alcohol to alleviate the stress we have felt on a certain occasion. Imagine what it would be like for a person recovering from a serious alcohol problem who is already experiencing alcohol withdrawal signs and now become stressed because of some external stimulus, such as seriously bad news.
Positive mood states (e.g. excitement) can also generate craving when having previously been associated with the pleasurable effects of drugs and alcohol.
People on a recovery journey need to learn how to deal with the cravings they experience. Fortunately, cravings gradually disappear over time, although the time for this to occur differs from person to person.
1. Gabor Maté MD, In the Realm of Hungry Ghosts: Close Encounters with Addiction, North Atlantic Books, USA, 2008.
2. Patrick Beirnacki, Pathways from heroin addiction: recovery without treatment, Temple University Press, 1986.
3. James McIntosh and Neil McKeganey, Beating the Dragon: The Recovery from Dependent Drug Use, Pearson Education Limited, UK, 2002.
Factors That Facilitate Addiction Recovery (pdf document)