The Person - Ready To Change
The addicted person – is agreeable or committed to stop using drugs.
There are many parts to substance use/addiction. I think it is important to understand a bit about the journey and the consequences of the journey, before we get too caught up in what we need to do about it.
While FASO’s are important, to be effective they need to be trusted. I have seen kids with drug problems give their Social Security payments to their parents who have promptly spent all their money and given the child nothing. You can’t live without money. Everyone needs money to a greater or lesser extent. Money makes the world go round – it allows people to provide themselves with a place to live, food, security, clothing and the ability to solve problems in their lives.
Social Security : money buys security and peace of mind
People with drug problems can also be taken advantage of - by seemingly caring FASOs. Not everyone can be trusted. Not everyone trying to help you is you friend. (E.g. A Family member ripping off your money). Not everyone who is hard on you is your enemy (e.g. Parole Officers often try hard to get things to work for the people they are looking after and give quite a lot of latitude to the people who are entrusted to their care). (Believe it or not- sometimes the actions undertaken by authority such as police – may well be in the person’s best long term interest).
The strategy to assist Substance Users / Addicts (drug addicted persons) is essentially a continuation of the process already started in the pre-commitment phase. Except now as you look at all the problem areas, identifying the problems the person faces, you look at how you can help the person to improve or to achieve a resolution.
The social security umbrella
Dr Xxxxx : The problem areas are:
Psychiatric issues especially depression and anhedonia, boredom
Employment or job issues.
If people do not give up drugs, they almost inevitably die eventually.
Drug use is a very dangerous – in fact often a lethal problem. One single mistake can be lethal or life changing. An addict just to survive needs to get “lucky” every day.
It is not just a simple issue of telling someone to do without drugs. You may as well tell them to do without sex or food or water or alcohol. FASOs (family and significant others) must work hard to maintain a working relationship with Substance Users / Addicts (drug addicted persons). To Influence someone, you need to be a part of their world. If FASOs (family and significant others) become too angry to work with Substance Users / Addicts (drug addicted persons) they lose their capacity to influence them.
Families are important in helping "Users" - stop using.
Directed anger and controlled anger can help FASOs (family and significant others) to maintain energy and focus on the problem of drug addiction. It can help to maintain alertness and to maintain the push for the achieving of reasonable goals.
Misdirected anger and abuse achieve little except the repudiation of FASOs (family and significant others) by the user. You cannot attain trust and empathy in the face of anger and abuse. Without trust and empathy, you cannot influence the Substance Users / Addicts’ (drug addicted person’s) behaviour.
FASOs (family and significant others):
Dr Xxxxx : Understanding
How drugs affect your mind.
There are many different drugs, all with different effects, but let’s focus on “overall”.
Most drugs are associated with “ups” and “downs”. People take the drug because it gives a big push up, but there tends to be a compensating big and prolonged fall “down” as the brain adapts. Substance Users / Addicts really feel good on the up, and really feel bad on the down. Generally the down lasts a lot longer than the up. The substance user / addict experiences that “most” of life is very unpleasant unless drugs are taken.
I’m talking here just about the drug effects of up and down. There are “adaptation” effects as well.
Prolonged use of drugs such as the narcotics especially, causes a withdrawal syndrome. Drugs such as amphetamines or speed are thought not to cause a withdrawal syndrome. There is however a very prolonged period of time after using, when the brain stays in a downstate. So being “off” drugs begins to be very uncomfortable. In the case of narcotics such as – heroin, morphine or codeine – there are prolonged and very real physical symptoms which can take up 2 weeks to resolve.
(Sometimes much longer times are reported to be required for withdrawal type symptoms to normalise). In the case of amphetamine, there are prolonged “getting used to living off my drug” symptoms, which take months to resolve. Methadone is reported to have a long withdrawal period as well- often up to months.
A disproportionately higher number of people becoming involved with drugs have underlying psychological issues when compared to “normal” people – who are not drug addicted. Depressions and anxieties are particularly common. The reality is that many drugs assist to reduce these symptoms. But there is a substantial price. Drugs such as the narcotics, amphetamines, hallucinogenic such as marijuana and LSD can make you feel better. But they do not remove the underlying depression or anxiety symptoms. They simply mask it for a small time.
Antidepressive and antianxiety medicines control the symptoms of depression and anxiety much more consistently and much more pervasively and much more effectively than drugs such as the narcotics, amphetamines or hallucinogenics.
It is very important in Substance Users / Addicts (drug addicted persons), to fix underlying psychiatric illness. Depression makes people feel sad. It also makes people feel very unmotivated. It is also common for people to be very irritable. It can be associated with very unusual thoughts, very intense thoughts and very inappropriate thoughts. Illicit drugs patch up the symptoms temporarily, but change nothing.
Erasmus : Substance Users / Addicts (drug addicted persons) need to be given an option to control their psychiatric or psychological symptoms with appropriate medications, not with illicit substances.
Illicit drugs in the down phase, cause a number of symptoms.
People can feel bad or unwell. This itself can be significant.
People can become angry, irritable and hard to live with. This itself can be very significant.
People’s behaviour can change – through drug seeking, through hiding their problem, through justifying their problems to themselves and in refusing the negative opinions of others. This itself can be very significant.
The lifestyle of Substance Users / Addicts (drug addicted persons) is very disorganised and not conducive to feeling well. One of the most important things and most basic things to good health is routine.
If you go to bed relatively early and have a reasonable night’s sleep, you will feel relatively better the entire next day.
If you eat regular and nutritious meals, you will feel relatively better the entire day.
If you wash and shower regularly, if you brush your teeth regularly, if you wear fresh and clean clothes, you will feel relatively better the entire day.
People with drug addiction issues with illicit substances, in short will feel better if they adopt a normal living routine. Such a routine helps them to look after their own physical needs. Such a routine makes them feel better. Illicit drugs introduce an element of irregularity in self-care. People with drug addictions begin not to feel well – because they do not look after themselves well.
Illicit drugs can make you someone else. Drugs change people’s behaviour. Narcotics make you feel lighter and happier and better about yourself and make you relate easier to other people. Amphetamines give you drive and energy. They help you to do lots of things and to pay attention to many things. Hallucinogens make you imagine and dream.
This is probably one of the most ignored aspects of illegal drugs. They help you to be who you may like to be.
Erasmus : Enneagram genetic personality theory describes how each personality type has a specific genetic mix of brain receptors. Human beings however in having a mind are able to critically look at their personality and may wish to indeed be someone else.
Dr Xxxxx : A self – pres enneagram subtype would be expected to have low inherent brain narcotic levels. They may well feel better with an adjustment to their natural brain opioids. Low adrenaline brain subtypes (e.g. esp. 1, 8), may well feel better with adjustment to the natural brain adrenaline levels. Low serotonin brain subtypes (e.g. esp. 1, 8) may well feel better/different with adjustments to their natural brain serotonin levels. Low dopamine levels can impact severely on motivation.
Understanding Enneagrams gives an understanding of behaviour.
This “personality “ aspect of drug use is probably an aspect of psychiatry of psychology which I think currently the medical industry deals with very poorly. However I think it is the wave of the future. To look at the brain function and to institute small changes to improve psychological function.
Understanding Enneagrams gives an understanding of behaviour.
Dr Xxxxx : Drugs can act in a toxic way damaging neurones. Drugs can facilitate the development of neural “loops” – whereby the person begins to think more and more about drugs . People find it to be very difficult to develop a life without drugs. Another way to describe a “neural loop” may be to describe these as “obsessions”. Obsession is serious symptoms of developing brain dysfunction.
Erasmus : In short there are many different facets to the “rollercoaster” of drug use. It is very difficult to break away from the drug world without support or assistance. The brain function of the Substance Users / Addicts (drug addicted persons) is too compromised to allow for easy release of bad behaviours such as drug use. The brain of the drug affected person could be described as somewhat “cooked” or changed. With continued drug behaviour it becomes increasingly difficult for a person to break away from their maladaptive drug behaviours.
Dr Xxxxx : The key issues in minimising substance use
(especially opioids) are:
- limiting time
- limiting money
- rebuilding a life or lifestyle
- having reasonable expectations and
- Getting on an ORT program
Users with time and money to burn a much more likely to return to using.
How can you reduce a user’s time?
One parent I know asked her son to come and visit her every day and help her with a few things. Time is spent getting to mum’s home. Time is spent doing some jobs. Time is spent having lunch. Time is spent talking. Time is spent going home. Less time to play up with drugs, the result. A simple formula with dividends.
Chaperoning is important
in helping "Users" to stop using.
Dr Xxxxx : Go to Work
The substance user/addict may need help with completing resumes, looking for work, filling in work applications, attending work interviews – especially if they have limited transport options and getting references. Finding a new job is hard work. In Australia, the employment agencies will try hard to find you a job. Remember that it may take time for a substance user/addict to be ready to return to work. To be successful at work, the psychological state must be in balance, cravings and illness needs to be under control and often many problems in a person’s life need to be at least heading towards stability.
Dr Xxxxx : Work Checklist
When a substance user/addict returns to work, there is probably a lot at stake in making this transition successfully. Many problems will normalise if the substance user/addict can integrate work back into their life. Realistically many substance users/addicts to take a long time to return to work. The attitudes and psychological factors which lead them into drug use, probably make them less likely to fit into a work environment and to deal with other people. An adjustment phase is important. It is important to stay onside with the substance user/addict. So maybe you can’t say all of these things you think need to be said at once. Maybe some of these things need to be said at the right time – when the person is vulnerable and likely to hear what you want to say.
Many work environments have requirements for “average” or “routine” presentation and interaction. If you don’t fit in – you may not pass your probationary period of work. Some industries such as the professions are particularly demanding of “fit in” presentation and interaction.
Dr Xxxxx : 1. Presentation.
Hairstyles need to be average. Greasy and oily hair may be acceptable for rock stars but needs to be presented very carefully in most “usual;” workplaces. Hair tends to easily look dirty and unkempt. Some hair sprays or gels may also create a similar “unclean” appearance.
Clothes need to be consistent with what is worn by other people in the workplace.
Standards of presentation and personal hygiene need to be consistent with that of other people in the workplace. Obviously there is a different standard of presentation for a concreter as opposed to a professional office worker.
People judge you by how you present yourself.
Average is better, to fit in with the workplace group.
People generally do not value extreme individualism or uniqueness.
Dr Xxxxx : 2. Social Interaction
Is important to be friendly and engaging to help you fit into the work culture.
Say” good morning, how are you? ” and smile to everyone.
Don’t just go “hey” and walked to a desk and not speak to anyone.
Develop some other interests whether you like it or not. Sport is an interest which is often discussed and can be used as a conversation entrant. I think a better access point to conversations can be gained by simply watching the news for 30 minutes every night. There is always something to talk about on a range of topics. Computer games can be a difficult topic to talk about. Talking about politics has its inherent dangers – if you hold opinions contrary to those of your co-workers. Take the time to fit in at work.
You may have lots to offer, but by broadening your interests you can get much further in life and in work.
Go to work functions such as drinks after work. Make an effort to go out of your way to talk to people and to interact with them on such occasions. Don’t just sit there using your phone. Don’t just sit there watching videos or music or other entertainment on your phone while you are with other people.
(Working hard at work doesn’t always give you the rewards you want. A friend was told by his boss that he didn’t think he would amount to anything. My friend said but I do the work of 2 or 3 people here. The boss said that’s exactly what I mean. My friend asked what he was doing wrong the boss replied, “Do the work of just one person – the same as everyone else. The rest of the time, spend the time interacting and talking with other people and promoting yourself. It is the people around you who give you cookie points for your work performance. The volume of work is likely much less important. You are much more likely to burn yourself out working hard and gaining little recognition or appreciation as well.).
Erasmus : Don’t be late for work. Being half an hour late for work is not good in many workplaces. People may not say anything about it, but they will notice it.
Kinkajou : Take the time to do regular exercise. There are tremendous benefits to how you feel and what you can do.
Erasmus : Keep up with your efforts to avoid drugs. Drugs mess with your head and can make it normal to behave and interact normally.
Erasmus : Don’t just keep to yourself. That often doesn’t achieve anything.
If you want to succeed in life and work on happiness – work is a very important part of that formula. Fitting in with a work culture is not wholly about the work you do. There are many aspects of social interaction that are important as well.
If you can’t beat them, join them. Sometimes in life we have to do things to fit in that we might not otherwise want to do. But fitting in gets you involved in life, conversation and interaction with other people in the workplace.
"Fitting in", is an important step in a " User's " Rehab.
Kinkajou : Hobbies or clubs or training programs or employment training can help.
Kinkajou : Good amounts of sleep.
(A normal person should sleep usually 7 & half hours per day. People who are suffering from some fatigue may need up to 9 hours per day. Sleep is important.
Kinkajou : Daily routines are important as well. Get up. Shower. Dress. Have breakfast. Brush, Floss, and Pick your teeth. Clean up after breakfast. Have lunch. Do a few jobs around the house. Wash your clothes. Do some maintenance activities around your residence. Have dinner. Watch TV. It is important to use a routine. Routine is paramount. Don’t let playing a computer game become the main activity of the day. It is certainly an easy thing to do. But it should never be the only thing to do.
Kinkajou : Therapy programs: It is important to involve professionals in a rehabilitation program. Starting an exercise program is an excellent idea. The internet can help with this but so can an exercise physiologist: usually available via Care Plans in Australia.
Seeing a psychologist and seeing a psychiatrist and seeing a doctor all take time.
I think the routine of picking up ORT doses at the chemist/pharmacy/drugstore creates an event which helps to fill the day. (While injections of buprenorphine have been suggested to be the answer to many opioid addictions, the physical act of travelling to pick up the dose and then travelling home is actually an important facet of therapy – perhaps as important as taking medication itself).
Erasmus : Being Burnt.
If you are trying to help a substance user/addict things can go wrong. They will not always be grateful for what you’re trying to do. Many addicts continue to use and may steal and sell household belongings – often relatively secure in the feeling that you (FASOs) are not likely to complain to the police about them.
Being burnt but being there: you need to help but don't make yourself a victim . It leads to "helper burnout".
Dr Xxxxx : Substance users/addicts commonly steal other people’s medications, jewellery, wallets and money.
Bad behaviour such as violence and unpleasantness and mood changes are common.
Police may raid your house.
They may store drugs in your home with potential criminal legal complications for you.
They may have hygiene and cleanliness issues and be very resistant to you pushing to initiate change. As a general point it can indeed be very difficult to tell someone that they smell bad, that they need to brush their teeth, that they need to change their clothes, and that they need to show some care for their appearance.
Don’t carry another person’s medications or drugs on your person.
Even legally dispensed medicines are dispensed to an individual. Technically, only that individual is legally allowed to carry their medications. Another person is generally not allowed to carry someone else’s medications. This is especially true for ORT medications. I have commonly seen the problem of the wife of a user on the program – being caught by policed carrying their partner’s dispensed Suboxone/Subutex. When the police confront them and search them – the drugs are found in the possession of the wife – who is not allowed to be in possession of these narcotics because they are not prescribed for her. The police can be reasonable. The police can be unreasonable. Policeman and policewomen can have bad days and good days. Do the legal and correct thing – and don’t tempt fate.
As a general rule if you want to help a “friend” coming out of prison – do not have them at your home. I have never seen this scenario end well. The person comes to stay with you because they have nowhere else to go. They usually out stay their welcome.
When you are forced to evict them, this eviction elicits an anger response. You can’t be angry and show gratitude at the same time. I strongly recommend that if you want to help a “friend” coming out of prison – that you take whatever spare money you have and put them up in a motel for one or 2 weeks. Then the motel owner is responsible for evicting them. There is an end to the largesse and financial support. (If they live with you, your financial support is open-ended until you are essentially evicting them – with predictable unpleasant consequences). Always put a timeline on any assistance you provide. For example, I will help you with food every day for a week/month. Repeat this timeline to the person you are trying to help every time you see the person you are trying to help.
Make sure that you keep your affairs separate from theirs. If you tangle your lives together, this can get ugly. I have heard of ex-prison buddies raping their mate’s wives and beating their mate’s wives up. And in spite of this, it’s unlikely that these new household tenants from prison will be grateful if you evict them from your house – even after such events. All you earn for your good deeds is hatred and anger.
Being a chaperone Requires that a substance user/ addict is asked where they are going and to make an agreement about how long this should take and when they will be back. Perhaps even go with them, if they are for example going out to get some petrol for the car. It may not be reasonable to be gone for an hour to go to the shop down the road or get some petrol. I have heard of a case where one user went to get a packet of cigarettes at a shop and borrowed a friend’s car. He returned 12 hours later- having burnt out the brakes on the car and having refilled the petrol tank several times. He was so stoned he just kept on driving with no idea where he was driving to. Accelerating and braking on hills aggressively burnt out / used up the brake pads- a cost to repair of about $700.
In the difficult case, where a substance user’s behaviour is extremely drug seeking, remember that discrete electronic surveillance is possible as well. GPS trackers on phones exist. Software telling you a person’s location with their phone can be used. Access to cars can be limited.
If they are not living at home, set up regular visits. I would suggest at least weekly. There are some issues with regards to staying at home. If they live at home with you, you can apply supervision and assistance easily. You may also get yourself in trouble if the police raid your house looking for drugs.
Dr Xxxxx : One of my patients heard a knock on his door. As he slowly lifted himself out of his armchair and shuffled towards the front door, the front door flew off its hinges almost knocking him down. Torrents of armed police surged into the home and proceeded to up-earth and search everything within the house. After trashing the house and finding nothing, they left the house saying “sorry about that”. The violence of the home invasion and the intrusion into his personal space left him numb and shocked for days. If the police find anything to justify the raid, the expenses and damage are yours to deal with. They won’t even say “sorry about that” as they leave.
It may be important to regularly search a substance user’s room for drugs and implements to minimise the chances that you (the house owner) may be convicted for possession.
Similarly if you travel with a substance user/addict in your car.
If your car is stopped and searched, you - the driver or the person in charge of the vehicle may have a problem if drugs or implements are found. You would hope that the substitute addict would confess to the ownership of drugs or implements that may be found. Of course they may say that they have no idea how these things came to be found under the seat of the car. The police then have the option of charging the substance user/addict or charging you both.
Things can become even worse if weapons such as knives are found in the vehicle.
We all tend to hear what we like to hear.
Dr Xxxxx : Some Getting Along Rules FASOs - Users
So if you have a friend who is a substance user or addict –
Do NOT loan them your car
Perhaps arrange to meet at a public venue such as a restaurant and make your way independently there to meet them.
Do not carry medications, including legally dispensed medications for the person. Legally dispensed medicines are prescribed for a specific person and you “could” be charged if you are in possession of somebody else’s medications.
Do not let them stay at your house.
Do not give them access to your house. I have heard the example of user’s storing their drugs in a friend’s house to which they have access. (Safe for the user perhaps- no one else).
Money buys professional assistance. But most users are broke. So where does the professional expertise come from?
Dr Xxxxx : Reasonable Expectations
The People around a user can have as many problems coping with the situation as the users themselves.
A few issues:
When substance users/addicts are on an ORT program they still may use occasionally. Realising that their program medication blocks the effects of legal narcotics is a learning experience that many substance users/addicts go through. In short, it is not reasonable to think that someone who has decided to stop drugs, will never ever use again. They do. However, in general the road is towards better. People use less and less with time.
Don’t get hysterical. Focus on the problems you are dealing with day-to-day. Sitting at home and wondering how the substance user/addict may ever return to work, may rebuild the relationship and solve the financial problems is something that requires the substance users/addicts cooperation. It also takes time to solve problems. It is not something you can do by yourself and in a few minutes. Don’t obsess about it.
Lots of people get upset with comments such as: “why me?” “I shouldn’t have to do this.” “I don’t deserve this”. The reality is that life is a process that invariably runs into problems large and small. You just have to deal with them. “Catastrophising” does not help you solve problems. Deal with the reality in front of you day by day. Yes you have lost something – the “health” of the substance user /addict. But they have lost more than you have and desperately need your help as well.
Life can be hard,
Goo: Dur Dur etre baby. It's tough to be a baby.
Dr Xxxxx : You may need to see a psychologist yourself. You can learn something about drug problems on the Internet. It is however important to get some perspective from somebody who is experienced with dealing with drug problems they can help you to get a more realistic perspective of what may happen and what problems will be faced by themselves and the user over time. FASOs can develop anxiety and depression and become stressed by catastrophising over the problems of the substance user/addict. It would not be surprising that a FASO may themselves need medication to do with psychological problems arising from this substance use/addiction. A general practitioner or a psychiatrist can prescribe you medicines.
Dr AXxxxx : Careful who you talk to and tell about a person’s substance use/addiction. Some people understand, but many do not. Many people have ridiculous expectations based on a total lack of experience with this sort of issue. If you do not know the consequences of telling someone your secret – Don’t. Advice such as stopping an ORT program and that you shouldn’t need this type of medication runs in the face of substantial medical experience. Only an idiot would suggest this to you.
Erasmus : Finally, some people really do like using. They really enjoy what drugs do for them. For this sort of person getting them to reach a goal of only using once a week is far better than using once a day. But of course -it’s if none get through – that’s the real victory.
Cognitive Dissonance is one strategy for initiating behaviour change.
Providing a source of Cognitive Dissonance: Build up an intensive picture of how bad the drugs are. Then build up a picture of how the person would wish to avoid the drugs causing harm to them. Then use the contrast between continuing drug use causing a person harm and their desire to avoid harm.
Anger can be useful. A substance user/addict should see that their behaviour is seen by people other than themselves. Other people are watching them. Other people have expectations for their behaviour. Other people want them to avoid using substances or drugs. Other people want them to succeed. And that other people will get angry with them if they do not work to succeed.
Providing organisation: making appointments, getting substance users/ addicts to appointments, organising healthcare, organising finances, assisting with activities of daily living and self-care including hygiene, providing medications and especially multivitamins, supervising medications, perhaps providing transport.
Giving motivation and direction. For example, finding a job is a very imposing task if left completely to one person. Someone needs to provide the push to go out to look. Someone needs provide direction as to where to look, what to look for, where to find application forms and what sort of activities/work may be suitable.
Routine is an important strategy for initiating behaviour change.
Acting as a chaperone
Assisting with social support
Assisting with financial problems while limiting the availability of finances for substance use. Perhaps assisting with pension or unemployment benefit applications.
All these scenarios are complicated by the fact that not all the people around the substance user/addict are good guys. And not all substance users/addicts are bad guys. People are people. And there can be very bad behaviour on both sides of the substance using divide. In fact I think many substance users/addicts are very lucky if they can trust many of the people around them.
Assessment Sheets Alcohol
Assessment Sheets Amphetamines
Assessment Sheets Opioids