EP 57 Why Early Recovery Is So Challenging With Guest Nicole Miller

Living With Your Child's Addiction Podcast
Living With Your Child's Addiction Podcast
EP 57 Why Early Recovery Is So Challenging With Guest Nicole Miller
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Heather and guest Nicole Miller who is a certified drug and alcohol counselor and teaches addiction pharmacology to college students talk about how the brain is affected by substance use. The better we understand addiction the easier it is for us to collaborate with and support our kids. It also helps us take it less personally and have more compassion.
3 things you’ll learn from the episode:
How drug use affects the reward center of the brain
Why early recovery is so challenging
What Medication Assisted Treatment (MAT) is and how it helps someone in recovery.
Episodes to Listen to next:
Episode #27 Approaching Addiction with Love
Episode #7 The Difference Between Discomfort And Suffering
Episode #26 The Benefits of Making Decisions and How To Get Started
Nicole Miller’s Email – nic.triplett@gmail.com


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Transcript

This transcript has not been formatted or edited.

0:01

I’m Heather after many wasted years, trying outdated, approaches to my daughter’s addiction, that felt wrong to me harmed.

Our relationship and didn’t help my daughter.

I finally found an effective evidence-based approach.

0:16

That repair my relationship with her helped me.

Create my own peace of mind and made me an ally in my daughter’s recovery.

I teach you a loving and compassionate approach to help you encourage change.

Create connection addiction impacts the entire family system.

0:35

Family recovery is the answer.

Today, you’re going to hear a conversation between Nicole Miller and I about addiction pharmacology.

Is Nicole explained it addiction pharmacology is about drugs, the brain and what drugs do to the brain.

0:55

I wanted to have this conversation to help you understand addiction better because the better we understand addiction, the easier it is for us to collaborate with and support our kids.

It also helps us take it less personally which makes it way less painful and Have more compassion.

1:13

Nicole is a certified alcohol and drug counselor in the state of Oregon.

She’s also a certified professional coach Nicole holds a bachelor’s degree in human development and has worked in the addiction field.

Since 2010, she provides coaching and case management to individual families impacted by addiction.

1:33

Nicole also teaches addiction pharmacology for college students and other individuals, seeking to earn certification as an addiction counselor.

And she has a significant knowledge and expertise of the ways in which addiction, Alters the way the brain functions and the difficulties individuals face in recovery.

1:51

As a result of this Nicole is passionate about, helping our clients.

Achieve long-term recovery as well as providing high quality training to those seeking to become helping Professionals in the addiction field.

I will put Nicole’s contact information in the show notes and I hope you enjoy the podcast episode today.

2:12

Everybody.

Welcome to another episode of the living with addiction podcast.

I’m here with Nicole Miller and we are going to talk about addiction pharmacology.

So Nicole, thank you for coming on the podcast today.

2:27

I appreciate you making the time for it.

I know how busy your schedule is.

Yeah.

Thanks for having me.

I’m excited to be here.

Well first, do you want to explain what addiction pharmacology is?

Yeah, totally.

So, So how’d the short answer and what I tell my students when I teach this class is essentially, we’re talking about drugs, the brain and what drugs do to the brain and in the, you know, in the realm of like addiction.

2:53

And you know, when drugs enter the brain, the changes that happen.

We talk about things related to tolerance and withdrawal and just all of these changes that happen in the brain.

So, okay, that’s a great explanation, easy to understand and really important because I think, I think that I really even though I was dealing with my daughter’s addiction, that was probably several years in before I really started, actually researching addiction, which seems like anything else.

3:24

Any other thing like somebody had cancer heart disease or something like that?

We would be getting more education on it.

So it only makes sense to get more education when what your child is dealing with addiction as well.

So what does addiction do to a person’s brain?

3:41

Oh my gosh, so much so and yeah it’s hard to even know where to start but essentially it changes the wiring it changes the way your brain operates and it does it in a really important way.

So I think you know a lot of people have heard that right addiction changes the wiring of your brain.

3:58

Like what does that mean?

So the primary parts of the brain that all drugs of abuse impact are the parts that are associated with reward.

So the same part of your brain that when You satisfy a survival need, so when you eat food, you know, and we have sex, you know, things like that.

4:18

It sends out there were chemicals neurotransmitters and that tells us this is important for survival.

Keep doing that.

So drugs activate that same part of the brain and they do it on a much much larger scale.

4:35

So for somebody who is struggling with addiction the drug Ugh, as far as their brain concerned equal survival at that point.

And then what happens when people go to get in recovery and start to get sober is that their brain has become accustomed to dopamine is the primary neurotransmitter.

4:57

Their brain has been accustomed to levels that are way way higher than what normally rewarding things would give them.

So one example I use is like hanging out with your kids, right?

Maybe For you’re using you really enjoyed that connection and it was really gratifying and rewarding you go through a period of addiction.

5:20

Whatever that looks like and then you come on the other side of it and here you’re trying to be sober and you’re doing things like hanging out with your kids and things that are supposed to feel enjoyable and it’s just it’s not registering.

And so that’s you know, really one of the big things, one of the big challenges that people face in early recovery.

5:37

Is that nothing feels good.

Okay, you made.

So many great points.

I want to look at a couple of them individually.

One of them was you were saying that the rewiring or the wiring changes that happen in the brain and the reward system, tell the person who’s abusing or abusing the substances that this is important for survival.

6:03

So it feels that important to them to use Yeah, yes exactly.

It’s because you know, the part of the brain that we’re talking about is like the oldest part of our brain, so that it evolved before our ability to think.

6:18

And reason and plan and problem solve, and all of that stuff, this is that basic primitive part of the brain that says these things feel good do more of that that these things over here bad scary and could kill us do less of that.

6:34

And so anything that activates that Reward Center to that That high of a level, the rains, like, oh, I must need this to survive.

This is the same thing.

When you eat food, it’s the same thing, the same process.

And that part of the brain is so is so focused on Survival.

6:54

It doesn’t really care about fulfillment, right?

It’s just mainly whatever it takes to keep you alive.

Yeah.

And when you mean, when you say fulfillment, well, I mean, like one of the other things you were saying is like Day things aren’t as satisfying.

7:10

So spending we wonder like, why a mother wouldn’t enjoy spending time with her kids or wouldn’t even be able to quit to spend time with her children or why our kids don’t care about the things that they use to love anymore and it’s because their brain is wired to.

7:29

I have to have this drug to survive versus seeking fulfillment in other ways.

Yeah.

And one point I want to Make is when so the earlier that somebody starts using the worst, this is so, there’s a big difference between someone who starts using an adolescence compared to someone who starts using in adulthood in adolescence.

7:51

You don’t have anything to compare it to.

So, in terms of like rewarding experiences for adults, the adults have gone through enough of life that they’ve had connected relationships, or they’ve had activities and things, they go out and do that to you don’t bring enjoyment.

8:07

And bring reward adolescence have not had that.

So their brain learns right away that it’s like to be rewarding, it has to reach this high level.

So then that makes it even harder for an adolescent to quit.

8:24

Then when they’re trying to get sober, yeah, significantly hurt her because all the things that, you know, as an adolescent what do you do?

You want to hang out with your friends?

Pretty much hang out with your friends, right right?

Which connection so, Like all of the quote-unquote normal things that an adolescent would enjoy aren’t like, literally are not hitting the, you think about what’s that thing at the carnival where you hit it and it goes up.

8:50

Oh, yeah, yeah, right, yeah.

So it’s like, hitting that over and over and over again and never hitting the Bell.

That’s what it’s like for adolescents.

And the numbers, like the research shows that people who start using in adolescence compared to someone who can delay, use until even 18 or 20 the Rates of addiction, errs significantly higher, for those who start in adolescents, and does that mean that it takes longer for them to recover, or just that it’s harder there takes their brain longer to heal?

9:22

It, could it means that they are going to have a significantly higher chance of developing into full-blown addiction.

Mmm, then if somebody uses meth at age 25, I’ve compared to age 13, their chances of developing full-blown meth addiction or significantly lower.

9:44

It doesn’t mean, it can’t happen, right?

But significantly lower than the Adolescent, who starts using.

So that’s a great point because that goes to people always want to bring Choice into it, right?

And which I don’t even think is maybe the first time it’s a choice, right?

10:01

But then, every single person is different.

Everybody’s brain is different.

Some people maybe that choice, This lasts a lot longer and other people are much more predisposed to getting addicted sooner.

And it sounds like adolescence is one of those factors that makes somebody predisposed to getting addicted sooner.

10:19

Absolutely.

Yeah.

So now what is happening in the brain when somebody is there trying to be in recovery, so they’re trying to be completely abstinent from the substance that Their brain thought was really important for their survival.

10:40

Mmm, such a great question.

So, you know, there’s quite a few stages that people have to go through, especially in early recovery.

So there’s the acute withdrawal, which is different, depending on whatever substance somebody is using.

So that first from the time, they stopped using till could be a couple weeks for some substance, could be up to a month that acute phase where they’re in physical psychological withdrawal.

11:05

If it’s something like opiates, they’re very If it’s something like amphetamines or other stimulants, very very tired.

So but once they get through that phase then it’s like the everything else.

So for one their brain is having to figure out how to navigate the world with like normal rewards and so one thing a lot of people experience is, so it’s called anhedonia.

11:30

So anhedonia is the inability to feel pleasure from normally pleasurable things and so and the dodea is like like I used to really enjoy XYZ and I just don’t I used to enjoy hanging out with my kids and it just does like I don’t feel anything and I’m not excited about that and that you know, that is literally their brain expecting so much dopamine that it was getting from drugs and it’s not getting that because Normal rewards don’t register that high they Create that much dopamine.

12:09

So with that, that can look a lot like depression, right?

It doesn’t mean it’s like true clinical depression, but it can look a lot like somebody who’s depressed.

There is this whole spectrums of post-acute withdrawal is like basically the whole two years up to two years after someone stops using and the big symptoms of that are.

12:30

I can’t think straight.

I have trouble sleeping either, I’m sleeping too much, I can’t sleep at all.

My emotions are all over the place.

Face.

So I’m having either numbness or extreme emotional reactions.

Nothing feels good and like, I don’t want to do anything.

12:47

So and then also I may or may not be wrong about.

This is their brain also producing less dopamine than say yours or mine would at that time as well.

Yes yes so and so did we talk about dopamine?

13:03

Dopamine is like the big kind of primary neurotransmitter, but depending on the substance, there’s serotonin there’s epinephrine.

There’s an orphans and all substances kind of have their specific brain.

Chemicals that they interact with.

13:18

And yeah.

What happens is in some cases the brain is producing less of those because the brain is learned.

Oh hey.

This external thing is going to come in and do this for me.

So to keep it safe because the brain wants to be, it’s called homeostasis like a state of balance.

13:35

It’s going to adjust so it will start producing less of those neurotransmitters.

The other thing that happens is, so on all of our brain cells, we have what’s called receptor sites, And so, you think of the receptor site of a brain cell like the lock and the neurotransmitter is the key that activates it.

13:54

So one thing that will happen in the brain is that the cells will down-regulate, so they will have less neurotransmitter or not.

Scuse me not in transmitters, less receptor sites.

So, what that means is the brain, then needs more of whatever it is, and this is part of how tolerance develops.

14:12

So for talking about heroin, the brain then needs.

Or heroin to get the same effect, okay?

And so then a person in recovery whose brain is making less and I’m just going to say dopamine even though there’s lots of other neurotransmitters.

14:29

Their brain is making less dopamine and they have less receptors to absorb the, the smaller amount of dopamine that they’re making as well.

Yeah.

And so, how long typically does that last for a person?

14:46

So, you know, that’s a bit until one of those big like it can very kind of things but you know, we’re talking about that post-acute withdrawal and kind of the brain trying to reset itself.

It can be years.

I mean, two years is kind of the standard when we talk about like post-acute withdrawal, but for some people it can be longer.

15:07

They I think it depends a lot on the person and their individual just biological factors.

It depends on what?

And how much they were using.

And for how long all of that stuff can impact it.

So, when somebody’s trying to get sober then they’re having to navigate restarting, their life, right?

15:31

Or I say restarting like General most of the time it’s completely starting over and they have to do that without the what I’ll call feel good chemicals that you and I have Depend on to get through the day every day.

15:49

They’ve got to start their whole life over like that.

Yeah.

I mean that, like in a nutshell is so much of what makes early recovery challenging and what can make it so hard for people to stay in recovery because it’s kind of like this.

16:06

Wait, I got sober to like, feel like this all the time.

She’ll like that all the time because I’m feeling I wasn’t sure if we can.

Yeah.

Bad words here.

So I feel like shit and the thing is is it can come and go you know so it’s not that it’s like two years of Perpetual just feeling like garbage all the time.

16:28

There will be periods of kind of feeling more normal and then it can come back and you can be going through that again, that can be really challenging particularly because when people are coming out of addiction, a lot of times we’re not like well equipped with like lots of coping skills and a lots of distress tolerance and All of that stuff.

16:48

Yeah.

And then without like this understanding to, I think one thing that comes up for a lot of people is this feeling of what am I doing wrong or what’s wrong with me right?

Because somewhere in there you get this expectation will if I get clean my life is supposed to get better and I’ll just feel better.

17:05

Yeah why don’t I feel normal now?

I stopped.

Yeah yeah yeah I stopped at a very discouraged point.

Yeah, okay.

And so, you mentioned post-acute withdrawal, is that CS symptoms or syndrome syndrome, okay?

Post-acute withdrawal syndrome or PA ws, and it lasts up to two years, so that can come and go this set of symptoms that you mentioned earlier.

17:33

And I can only imagine experiencing that Mike wondering what it is every time not really knowing second guess, Aang.

Is that really what it is, or should I be doing something else?

I can only imagine that.

That’s a huge part of the struggle with those two years of Really Trying To Get Back in Balance.

17:55

Yeah, yeah.

And then you mentioned the acute withdrawal phase.

I just wanted to touch on that for a minute because I’ve watched my daughter, she was on heroin and meth.

And so she was physically addicted to heroin and I’ve watched her go through withdrawals.

18:11

Several Times and it was really horrible.

It is.

I can’t even imagine somebody or facing that myself like knowing the pain that I was going to go through to stop doing something.

18:27

And so if you’ve never seen it before, can you describe some of what withdrawal symptoms are like?

Yeah, so it’s going to vary for all the substances, but if we’re talking about, like things like heroin and opiates, because some classes of substances have really intense physical withdrawal, symptoms, others like meth if somebody’s just using math like it’s uncomfortable and you don’t feel good but it’s nothing compared to like an opiate withdrawal.

18:56

So the things like opiates we think about like the worst flu you’ve ever had complete with those stomach stuff so you puking your Having diarrhea, you’re sweating.

You’re shaking the whole nine yards and you’re doing that for a week.

19:14

Maybe more for a lot of people.

It can be longer than that.

Feeling you know.

Like your skin is like literally just like that.

You’re crawling out of your skin.

Anxiety is a huge part of that.

Yeah it’s just awful.

Yeah.

And the the anxieties got to come from your brain saying hey we need that stuff to survive and you’re not using it.

19:34

Yeah, that’s exactly it.

Withdrawal is your brain and your body is attempt to get back into homeostasis.

So when we think of addiction, so when somebody is addicted, they are in essence normal, with the drug and withdrawal is not normal with out at that point.

19:53

Yeah, yeah.

There was one time I, it was hello.

Anna was going through withdrawals and she was trying to get to the point that she could take Suboxone and she was doing it at home and she Took the Suboxone too soon.

And went into precipitated withdrawals and ended up really in crisis.

20:11

She was having it was kind of like seizures, but not really seizures and we ended up having to send her to the emergency room.

And it was just a really, really horrible experience, and it gives me so much compassion for anybody.

That is facing going through that because even if they go to a detox and they are getting medically, assisted through the detox process, they have to be It’s far enough into withdrawals and quite uncomfortable for long enough before they can take something that’s really going to help.

20:45

Relieve that.

So I think that’s something like Helena for a long time.

When she would go to detox, she would end up leaving before she got to the place that she could take something, because the discomfort was so overwhelming of going through that detox phase.

21:01

So I just like to point that out for anybody that’s listening that has not Seen somebody go through that.

It is something really to have compassion for what that person goes through it off of those drugs.

Yeah, so much so so much.

21:17

So what else makes people susceptible to relapse in early recovery?

Is it just the lack of neurotransmitters and receptors?

Or are there other factors that contribute to that?

Just definitely?

21:32

I mean it’s so much to that.

I mean, yes, it’s the way.

Their brain works.

And if they’re in withdrawal, if they’re even in like psychological withdrawal.

I mean, if you were talking about like, stimulants people, they feel depressed and fatigued and like, they can’t get up and do things, and all of that.

21:50

But then, there’s even just the social factors, right?

Like, hanging around with people or wanting to kind of go back and make those connections.

I think, whether or not someone has support is going to be a huge factor in Whether or not they end up relapsing.

22:08

So I think it’s just kind of this.

What’s the word I’m looking for?

Like all of these things that kind of come together to like set the stage for that.

Yeah.

And we are talking about math.

I think people can end up being fatigued for weeks or months.

22:25

Right.

Like just wanting to stand all the time.

Yeah.

And it’s not laziness.

It is their body.

Genuinely needing that to So with things like meth there, so our body produces there, its own Natural Energy chemicals, so the two big ones are epinephrine and norepinephrine.

22:46

And so you think about any time, you’re in a situation maybe where you need an extra burst of energy, right?

So you are being chased by a saber-toothed tiger and you have to run away really fast.

Those are the chemicals that your brain is going to release more of to help like get you out of there.

23:03

When you use a stimulant it.

It releases way more of those chemicals without there being an actual need for it.

So that’s why people on meth get all Twitchy and 90 miles a minute and all the, you know, all the stuff that goes with that.

But what it does is it depletes, our own Natural Energy chemicals, you take that away and your brains like, well, I haven’t been needed here, so I’m not producing these to that level anymore and so yeah, you’re just like dead tired.

23:34

Yeah.

How do you know?

Like tired is not even like an adequate word for, right?

That is completed.

I would be glad to Bluemont.

Yeah, and another thing to really have compassion for when somebody’s going through that their body, their body, their brain, everything needs time to heal, and then, like you mentioned the factor the of community.

23:58

So all of their friends before were using or abusing substances.

And so now, Now, there’s a lot of times, maybe even if they don’t have the support system of their family, like, they’ve got to rebuild their whole Community again, and they said it’s a lot to face on top of not having not feeling well, and not having the neurotransmitters or the energy or anything like that.

24:24

That you need.

When you think about those things combined, I really just have so much respect and I think it’s amazing how hard somebody has to work to get in space.

Brr.

Yeah it’s nice.

24:39

That the stigma around addiction.

Has this idea that like well you should just be able to decide that you’re done.

Gets maybe get some help.

You know, that’s cool.

We’re on board with that.

These days, then just like, get back to it.

24:56

I’ll go do all the things that, especially as an adult, right?

Get a job, pay your bills, keep track of things.

Do all these things, but we have people whose brains these are not working, right, right.

Like they don’t, you know, they can’t think clearly, they can’t problem solve all of these things.

25:12

They feel like crap and they’re like well what do I do for fun?

Who I hang out with and it doesn’t even matter because I wouldn’t like it if I did right so what do I do?

All right.

Yeah and that’s why it’s a family support and connection is so important and why I also I’m just going to say this over and over again.

25:32

Probably in every podcast until you guys get some Of hearing me say it, that why?

I think it’s important to help make it easy.

Remove any barriers to getting help that you can for your loved one call around and then let them make the final call to get in somewhere but help them out.

25:53

Support them in the process.

Help them find a sober living to stay in like make it as easy as possible as you can for them.

That is not enabling like we Here that we, they should be the one.

I mean I’ve called rehabs before and had them.

26:10

Tell me, oh, well, your daughter should be the one calling, so you call and that you even get the messaging that what you’re doing is wrong and I just want to reinforce it is not wrong.

They say, if your daughter really wants to be here, then she’ll be the one calling.

Well, thank you.

26:25

But I’m going to make all the calls and find a good place.

And then just call you like, I’m just going to make this as easy as possible for her because she has enough to go.

Through.

Yeah.

And people can be working really hard at it and still struggling.

26:42

Yeah. 100%.

And I think about, I mean, Simon recovery and and I think about when I was in my addiction, I wouldn’t have had the first clue how to navigate the system of getting into treatment or doing any of that.

26:58

So I might have been like oh I want to stop and then that’s as far as it would have gone.

Hmm.

And I’m thankful that I had Add family that were willing to be there to help.

Because I would, I would have had no idea.

Yeah, yeah, it.

27:13

Absolutely.

The system has been overwhelming for me, right?

Like, I’m sober and I have the time and the energy and the brain power to do.

Make all of these calls and navigating insurance, and all the other things like it is overwhelming to try to figure all that.

27:33

Like, find the place that takes your insurance find him.

It’s going to cost when they can get in there.

All of these hoops that you’ve got to jump through.

I think that it’s hard for anybody less.

So like let’s just remove that and make it easy as possible for them to just like here.

Here’s a couple places decide where you want to go, right?

27:51

So I want to talk about medication assisted treatment for a few minutes because I think that I always cringe.

I’m in a couple of groups that are where, you know, people are talking about addiction in He will ask like my kid wants to get on Suboxone or something else.

28:12

Some other medication, assisted treatment and everybody starts talking about how bad it is because it can be abused.

And I think that it gets I consider it a life-saving medication but so many people have vilified it just because it can be abused that or they know somebody that have used it so nobody should ever use it.

28:34

So can you explain What it is?

Yes.

So medication-assisted treatment is in essence.

A treatment modalities is form.

Well, it’s not just opiates, they do it for alcohol and other stuff.

We’re going to talk about it in the context of opiates because that’s kind of the big one.

28:51

So it’s using a medication.

So typically some sort of opiate so the kind of the big ones are Suboxone.

Methadone is the one that’s been around forever.

It’s like the single most researched treatment.

Modality ever had because it’s so controversial.

29:09

There had to be like, shit, tons of research on it.

So using a medication to give to someone, who is opiate dependent with the purpose of navigating Cravings, so, or lessening cravings, and also keeping that person out of withdrawal, so that they can engage in a treatment program.

29:29

Go to counseling group counseling, individual counseling, so that they can engage in the rest of their Life.

You all the things that are expected, right?

Go out and get a job and repair their relationships and have fun.

29:45

Yeah, whatever.

All these things that people do in life than being able to do that because they’re not in withdrawal and they’re not having cravings.

Well, yeah, and Cravings with something that we have in hadn’t even talked about yet that continues with in abstinence, I know that that was something my daughter was still struggling with.

30:05

After months of being abstinent.

Yeah, I mean, Cravings can last for years and when a craving hits, when you’re sitting here and you’re not in the midst of one, rational, you know, that Cravings are short-lived, right?

30:21

They kind of come and go, but when you’re in the midst of one, it feels like it’s going to last forever.

And that is your again.

It’s your brain saying, hey, I need this thing.

I needed to feel normal and you too.

Get back to homeostasis.

30:37

So, and it’s coming from this subconscious part of your brain, right?

So nobody is like walking around going, oh gosh, I want to have a heroine craving right now.

They’re walking along minding their own business, doing whatever it is they’re doing.

And then suddenly, they’re in the midst of a craving, because they smelled something saw something, heard, something something happened at the subconscious level, that triggered that.

31:03

And that’s another thing that one can, Can catch people off guard like if they’re not, like if they don’t have an expectation, that that is a normal part of recovery because it is and it doesn’t mean anything.

A lot of times people like, to attach this meaning of I’m doing something wrong because I’m having cravings and it is this very temporary thing.

31:23

But people have to be able to kind of have an understanding of that and then have the skills to like manage through it.

Because when you’re in that, it’s really easy to get to that impulsive place of like, I’m having a craving like I have to fix this.

Go use.

Yeah.

So kind of going back to like medication-assisted treatment that is so the medication.

31:44

So you know, mothers methadone or Suboxone or now treks own, what they do is they go in and they occupy the receptors in the brain.

So they occupy it without activating it.

And each of those substances that I mentioned, do it in a different way and I could explain that if you want.

32:02

But so they’re occupying it.

So The receptors are Defied.

They’re like, okay, like I got what I need, but it’s not like getting them high.

Like I think one of the misconceptions and one of the judgments around medication-assisted treatment is that people are just taking these medications and they’re just getting high all the time for free basically and just having a blast, and it’s not like that.

32:25

So, so for Methadone.

So methadone goes in and now methadone is a full activator.

The word would be Agonist so it’s a full activator.

So if someone were to take too much methadone they would feel high and they could overdose.

32:45

Okay so if somebody is on a therapeutic dose and therapeutic doses, determined by the doctor who is prescribing it and the medical professionals in the clinic if they’re on that therapeutic dose, you wouldn’t be able to tell the difference between them them or you and I yeah.

33:02

So but it is a full activator so there is some risk.

If that in that, if people are not taking it correctly, not taking it as prescribed or using other things on top of it.

Like it can be.

It does have dangers as far as like overdose goes.

33:17

Hmm, yeah.

So that’s methadone, Suboxone is a little bit different because Suboxone goes in, and it’s like, if you think about that lock and think about having a key methadone as like, the key fits perfectly in the lock Suboxone, is like, the key goes in the lock, but doesn’t really turn.

33:35

Right?

So it’s not quite a perfect fit.

So what that means, is it still activates the receptors.

So The receptors are still satisfied.

The person still not in withdrawal but it’s not getting them high.

Now, for some people some people might report like and especially people who don’t have a tolerance will say that taking Suboxone and felt something from that and that can happen.

33:58

But in essence it’s nothing like going out and like taking a bunch of heroin or any other like for on Toby.

It.

It’s also safer because it has a ceiling effect.

So the ceiling effect means that you can only take so much.

And once you hit a certain point, like it’s not, there isn’t going to be any other effect.

34:17

So that is protective in terms of like things like overdose.

Okay?

So I’ve heard a lot of people say like oh it’s just switching one addiction for another, that’s guess.

People say that all the time and it’s not I mean, it’s just and that’s just such a harmful like Then we have to move away from because is it, are they using a substance to manage their symptoms of withdrawal and craving?

34:45

Yes.

But that’s very different than I’m out.

Abusing street, drugs and doing all these things.

If somebody is working the recovery program and engaging in medication-assisted treatment and all of that, that’s what we want.

35:02

And the reality is particularly for people who use opiates It’s and absent based treatment model sewn on medication, assisted treatment, the Dropout rates are astronomical.

Most people drop out at the three-day Mark and they don’t come back right or they can Trying by go right in.

35:20

Yeah, and I mean, they’re just not successful for people in medication-assisted treatment who are on a high enough dose because that’s the other thing is people think that they’re like, doctors and things like are your nose is too high.

And well, I don’t know about you.

I don’t have a medical license.

35:37

I saw my place to say and so they’re on a dose that is good for them.

Like you’re not gonna be able to tell the difference and if they’re out having a job or doing whatever living their life, who’s to say that’s wrong.

Let’s be really clear about the getting high part on the methadone.

35:55

I just want to hit that again.

So the getting high, it’s a very low level, right?

And you say getting high, I think you said, when you take methadone there is some high to it.

So methadone is a full opiate antagonist.

36:11

Okay so it’s a full opiate so anybody, so if somebody who’s never taken opiates and is doesn’t have a tolerance to them cakes method, Like they’re going to feel the euphoric effects, okay, but that’s one of the things that somebody in a medication, assisted treatment program.

36:31

They’re going to be working with a medical prescriber.

They take into account things like tolerance and history of abuse, and all of those things.

And so when that person is on their therapeutic dose, it’s not getting them high like their night walking around, right?

36:50

Okay.

Go ahead that way.

We clear clarified that.

Yeah, yeah but that is one of the things is because people can and because in these treatment modalities just like any treatment modality, I think it’s interesting how people get all fired up about medication-assisted treatment and like oh they like divert their meds or they like take it not as prescribed and it’s like I mean does that not happen in like other treatment modalities?

37:13

Like I don’t remember saying anything right?

So yeah and methadone is very highly regulated like when Helena was On it.

What’s really one in the beginning and until you build, I guess you after you’ve been on it for a while, you’re only, you have to go every single day to get your dose.

37:33

And one thing that really stood out to me, when I went to the methadone clinic with Elana was, she’s sitting there in the chair, she’s like passed out, right, because she’s been up all night.

She’s living this drug lifestyle and everybody else.

37:48

It came in.

There was like bright and happy.

They were on their way.

Way to work and I could just see and them like wow these people are really living a life in our happy about it.

It wasn’t just this, I could just really see the difference like in that moment I could feel the truth of how much that was helping these people to change their lives and it was nothing like somebody who was living in active addiction.

38:16

Yeah.

And I mean and that’s the thing is that for that population like To get to that point like it’s just not like the research does not support that absence based treatment is what gets them there.

And so for me it’s like if you need a medication to be able to live your life in that way and out of active addiction, then who’s to say that’s wrong.

38:40

So when somebody Lifesaver yeah I totally agree.

I feel strongly that if my daughter had stayed on Suboxone but she Would probably still be alive today.

I wish that she had stayed on it longer, and that’s one of the reasons I’m such a strong advocate for it and want people to be properly educated about it.

39:04

Because people who are in even in 12-step programs, you can’t get a sponsor.

If you’re on medication, assisted treatment, a lot of times, because those programs, don’t believe in it, they don’t understand it.

They haven’t changed with the times, but isn’t somebody’s brain also.

39:21

Giving their is that giving their brain time to heal as well like, they’re do their neurotransmitters start producing regularly and then they’re able to absorb them as well.

Is that healing taking place while somebody’s on Matt?

Yeah, because again, it kind of goes back to that that experience of like reward and that intense reward when they’re being managed, like they’re not getting those like huge hits of dopamine and it’s not Not the same as going out and doing a big ol hit of heroin.

39:54

It’s just not the same.

And some of the other things that are necessary for the brain to heal, and for all that healing to take place, is that like participation in life, right?

Like building, meaningful connections and relationships, and taking care of yourself, physically, mentally spiritually, all the things that people are able to do when they’re not having to worry about being a mature, all, and The stuff that comes with that.

40:23

Yeah, absolutely.

And that is just so important to observe the process of rebuilding.

Your life is overwhelming and if you think about just the small process, somebody goes through when they go through a divorce or a big move or something like that, it is just so stressful or a job change.

40:40

Right?

In this person somebody’s recovering, like they’re having to start over in every single area of their life, not just wine.

It’s so when you think about how stressed out you are about a new job Or divorce or move or whatever it is.

Imagine going through all of those things and then some all at once and I think that that gives a little bit more insight into what somebody’s going through.

41:05

The last thing I wanted to ask about was Fentanyl and because like I’ve heard that it’s more addictive and you have to use it more often than other drugs.

And that’s one of the reasons that fentanyl is getting Mixed in with a lot of other drugs.

41:24

So that that takes somebody who maybe was a casual user or not, using as much and now suddenly that person’s got to buy all the time because they’re addicted to Phan.

All.

Yeah.

So it is a short-acting obeah.

41:40

So when we talk about short-acting versus long acting toward acting means like you use it and peaks in the effects wear off very quickly.

So, when something is the same thing as Like Cocaine, right?

Like Anything about like cocaine, use people use cocaine and they binge on it because it wears off in like 30 seconds or whatever.

41:57

So fentanyl is the same is it wears off really quickly.

So people are having to keep going back and keep using more and the other, you know, one of the other big things we’re talking about fentanyl is you think about it and think oh, like they give that stuff in the hospitals.

42:13

But what’s on the streets is not MediCal fentanyl.

It’s this synthetic shit that’s made with all these like cheap ingredients.

That are so it’s easy to make a lot of it and it’s really dangerous maybe because you don’t know like what is actually in it and it seems like Street chemists that are making it.

42:33

Yeah.

So that is why when they’re trying to cut their drugs with fentanyl, why people are getting killed because they’re it’s not properly measured or managed or who knows how much actually ends up in there.

42:51

Roar what happened during the process of making it or I know that like when my daughter used wasn’t the first time she had used from whatever she bought.

But so like the whole batch that she had, I don’t badge, makes it sound so big, but whatever amount she had that she bought.

43:11

Like, it wasn’t all lethal, right?

Just part of it was.

And that’s what’s so scary about it is that you just never really Now, with it, and it is short, like, even the medical grade fentanyl is short acting.

43:28

Like I remember after my one of my surgeries last year they gave it to me just to get my pain down enough for me to get home and it was wearing off before I got home, which was like would that 30 minutes later?

I was the pain was coming back and I was like, this is not it is it wears off so fast so I can only so that they go into withdrawals that quickly as well.

43:51

They can.

Yeah.

Yeah.

Like they don’t have anything else.

They’re using those effects start wearing up.

Yeah.

So there you go.

They’re feeling sick sooner than if they had used heroin.

Yeah.

And then I guess since heroines not as strong, it just doesn’t cut it anymore when somebody is addicted to fentanyl.

44:09

Yeah, yeah.

And so fentanyl is way more potent and I can’t remember the exact number.

But then we compare it to things like heroin or like Oxycontin or some of the other.

Paying bills that are out there.

It’s significantly more potent than any of those.

44:26

So and I think the other scary thing with fentanyl is that you’ll have people that are using like stimulants like using other things.

So they don’t even know that they’re getting fentanyl, right?

They weren’t even planning to buy and opioid or right.

Which means they don’t have a tolerance so that’s why people are dying so quickly, it’s just so scary.

44:48

Yeah, it really is all the more reason to have Have fun all test strips and Narcan.

Yes and often when if somebody has used fentanyl, sometimes two doses of Narcan are needed.

45:05

So I’ve put links to those, I think I’ll put them in the show notes again.

I put links to those before but it’s good to know where to get them because we should all have it on hand.

Is there anything?

I think we covered everything that I wanted to go over.

45:20

Anything important that we miss that you want to go back to or you felt like you needed to explain a little bit more know.

I think that I was so I was thinking about medication-assisted treatment and I think the big thing that I teach this week with my students and it’s interesting because I teach people who are looking to become drug and alcohol counselors in Oregon.

45:45

This is like one of the required classes that they have to have.

So and I get just this huge Spectrum.

Mm of like opinions and thoughts and a lot of times it’s influenced by people’s own recovery.

So the thought is like, oh well, I got clean this way so like it should work for everybody Ray and we get all people get all judgy about all this shit which is crazy to me, right?

46:11

So sorry I but the one thing I really try to instill in my students is that there is no right or wrong answer in terms of how long, Somebody’s, and Max, and really, the research shows that longer treatment episodes are associated with better outcomes.

46:27

So like there is no right or wrong answer.

And if people want or need to be on it, long term like that’s okay and they should be.

Yeah, right?

Like somebody being on Suboxone for two years is vastly better than somebody od’ing on fentanyl in the streets.

46:44

Absolutely, absolutely.

Then with dosage to people go around thinking their doctors for hey you know, I was like you don’t get tell someone their doses too high or too low.

Unless you have a medical license and I just think that those things are so important because people can be influenced and you have your friends and all their opinions, and if they’re telling somebody, oh, you shouldn’t be on that or your doses to this or that, I just think that can be really dangerous or the bad story about somebody who abused it.

47:15

So, When somebody says something like that, like, well, I got sober a different way in my ways, the best way, or the only way like, can you imagine if like I had breast cancer last year, can you imagine anybody telling me the way I got rid of cancer was the wrong way because they know somebody else who got rid of it a different way.

47:35

It’s not.

Oh yeah, we just wanted to Chris.

Yeah, we just wouldn’t and the fact that this is like just somewhere where we’re so far behind as far as addiction goes.

Mmm.

Yeah.

That’s what we should be saying like whatever you need to get help and to be okay.

Yeah, like do that whatever.

47:53

Whatever that is on it.

Yeah.

Whatever life-saving tools you need like, we’re here to support you, whatever it takes and but I also feel like in some ways people in sobriety are told that as well and it’s like just perpetuating like they are taught to perpetuate the Sigma is they’re getting treatment.

48:19

And like, I’ve wondered that with my daughter, some things that we talked about.

Now, I look back on it and I think that she really believed that or was she taught that as she was getting sober.

And so, she believed it because that’s what she was told during the process known as I go back.

48:37

And I question a lot of things, and I think that just nothing wrong with questioning, we in really looking at things like Like, if this was an addiction if it was heart disease or if it was somebody was diabetic or had cancer or whatever, how would we approach it?

48:55

Like to help remove that stigma of that we shouldn’t help people or there’s only one way or if they wanted help.

They would figure it out or we wouldn’t tell somebody who had heart disease if they cheeseburger.

Oh well you must not want to be healthy.

Yeah.

49:12

Like, what’s worse?

If they want to help, they would figure it out and then they do figure something out.

And then we tell them, that’s wrong, exactly, right.

If you want to get to the hospital where you’re having now, heart attack, you’ll figure it out, right?

I’m not calling 911 for you.

You ate a cheeseburger yesterday and there’s just no way you did this to yourself, right?

49:31

So so much more compassion is needed but I think that this conversation will make it easier for anybody to understand and have more compassion.

Passion.

So I really appreciate you taking the time to come on today and I will put how to get a hold of you in the show notes, so if anybody wants to find out more.

49:51

So thank you so much.

Yeah, thank you.

I appreciate it.

Thank you for listening to this episode.

If you want to learn more about my work, go to Heather.

Ross coaching.com if you want to help other parents who are struggling with a child’s addiction, you can do it two different ways.

50:09

First, you can share the podcast with them directly or you can share it on your social media second.

You can leave a review, talk to you next week.