The road to sobriety and recovery brings with it many positive, life-altering changes; however, individuals must also be aware of, accept and manage the residual health effects from previous years of drug dependence. Clare Waismann, M-RAS / SUDCC II of Waismann Method® Advanced Treatment for Opiate Dependence and David Livingston, LMFT specializing in addiction therapy discuss the difficult transitions that occur during this time, as well as various techniques individuals can put in place to ease them. From recognizing their residual symptoms to creating personal goals towards achieving long-term stability and success in life post-treatment, both experts stress that there must be an honest evaluation of one’s situation before creating a supportive and successful plan for coping with such life changes.
Dwight Hurst, LPC: Welcome back to a podcast to answer your questions on Addiction, Recovery and Mental Health by Waismann Method Opioid Treatment Specialists and Rapid Detox Center. I’m your co-Dwight Hurst, joined by Clare Waismann and David Livingston. David and Clare. I have a what I hope is an interesting question. I think it’s an interesting question anyway. Today I want to talk about the difficulty people may have coping with some of the aftereffects that we don’t usually talk about when it comes to sobriety. The abuse of alcohol or other drugs can leave people with some residual health problems, perhaps new functional limitations. Sometimes some of that is just age because they haven’t been attending their health and it’s been a long time. Sometimes it’s things are actually caused by the substance. And so basically the question is, is which of those things are how do they impact people once they get sober and start managing their health again? And what do we do to manage that?
Clare Waismann, M-RAS/SUDCC II: One of the biggest issues that I see is the expectations of patients that been using substances for ten years to want to get detox and feel like they felt ten years ago and not just because of the effects that, A, the drug could have had on their health. And I’m not just saying physically, but almost always mentally, you know, there is a consequence of a certain way that you feel for a very long time. It’s difficult to transition to another type of feeling. So physically, emotionally, and all of the above. There are effects of the substance. So to expect to feel like you felt ten years ago, it’s impossible. Regardless, if you didn’t use any substance you couldn’t feel like you felt ten years ago. So I think that expectation is something that we try to make real clear for the patients that, you know, they are not 40 anymore, they’re 50. So and they haven’t really taken care of their body as they should have for the last ten years. So is dealing with realistic expectations.
Dwight Hurst, LPC: It’s such a huge outpouring that we see coming back around is expectations.
Clare Waismann, M-RAS/SUDCC II: Correct and supporting them from where they are once they’ve been detoxed and the things they can do to get better and feel better. So regardless, you know, they can always work on their health and, you know, get better. You don’t know what you feel when you don’t know where you are physically or emotionally. While there is a blanket between you and your whole body.
Dwight Hurst, LPC: I always remember someone that I met years ago who was heavily into his methamphetamine abuse, but they had been clean for years from it and they had a relapse to full use following the death of a family member. And the interesting thing was they were caught up in that for months and months. I remember if it was a whole year, whatever it was, but they said they sort of got reoriented back on their healthy to start doing some therapy again. They started, you know, just whatever the things that they did to be healthy and they stopped using meth. What happened was all the grief landed squarely on their shoulders, just as if it had just happened. And they always used that that that ex example to say, you know, you’re not really escaping what you think you’re escaping. Sometimes through substance use, you’re just delaying. And I’ve always thought that was very interesting.
Clare Waismann, M-RAS/SUDCC II: It is, I agree. 1,000%.
David Livingston, LMFT: Right, Right. Yeah. That. That we, we, we always remember ourselves on our best day. And. And it’s just right, I think we all do. And I mean, I’ve seen that so, so often it’s, it’s like the expectation that you get detoxed and you’re just it’s you’re going to be on your at your best day. And if something doesn’t feel right you know that there’s and that there’s kind of a panic. But part of it is also that the nervous system is so conditioned to feel like you need an opioid or something to make it right, because often that’s a sign that you’re going into some withdrawals or something. So you have this conditioned reflex that’s deep because it goes from the nervous system into the emotional life and the brain. And so over time, that gets maybe a little bit of time, maybe probably 20 days that unwinds and that conditioning really starts to give way and you start to go through some ups and downs and realize, oh, yeah, I didn’t feel so great today yesterday, but I feel pretty good today. And then you go through a few more of those ups and downs, you realize, Oh, okay, I’m just getting a new baseline of and, and then you start to regulate things like sleep and get some exercise and all the kind of the regulating processes that help us all sleep better and everything. And then you start to get those things in line and, and then and then if there is some underlying anxiety or things that beyond sort of the, the early part of recovery, you know, then you can begin to address that, whether it’s situational or it’s more systemically based or whatever it is. And I think a lot of what people call pause is an inability to differentiate these aspects because they can’t even remember, you know, a lot of it. And some of it’s new and sometimes their lives are very different then. So there’s a lot to kind of get oriented to, you might say.
Dwight Hurst, LPC: Yeah, you know, meeting people who have been in decades of use and decades of substance abuse to that point. One of the things that I hear from some people, if it’s been a hit adulthood, start abusing alcohol and drugs. Next thing I know, I’m 55 and I’m finally starting to get away from it. And now for those people, it’s not even a question everybody around them might be talking about, you know, reclaiming your health. And for them, it’s like, no, I’m claiming my I don’t I don’t know what it’s like to be free of some of these substances. I don’t know what it’s like. I’ve never done it. So, therefore, it’s a whole new thing to learn. And I think sometimes, as I know we like to bring this up sometimes on this program is that the advertisement for sobriety sometimes makes it seem like, “Hey, stop using, you’re going to feel great!” As if it happens immediately instead of like “Stop using, you’re going to find a lot of aches and pains and some psychological things you have to confront, and you’re going to have to do a lot of work before it starts being really, really fun.” But your health is, you know, you’ll be better and it’ll eventually, you know, it’s worth it. But, you know, we don’t always advertise that part. We don’t know. We’re not always honest with people because I just mean we as humans, sometimes people are so eager for their loved one or their client or patient to stop that. They just make it sound like it’s great to stop. Instead of saying, All right, let’s get ready for It’ll be hard, you know, but it’ll be worth it. And that’s it.
Clare Waismann, M-RAS/SUDCC II: But I think we’re talking about two different things there, Dwight! One is, yeah, it is great to stop. It is great to stop because the consequences of continuing are horrible and you’re truly not living life. You’re just, you know, navigating through it. Now, the promise that life is life, life on life’s terms is always going to be great. That doesn’t exist, not for somebody that use opioids or alcohol or any other drug or for any of us. You know, some people can have bad days, some people can have bad weeks, some people can have a bad year. It’s just, again, relearning tools of how to deal with those emotionally and physically, but then going back again that, you know, it’s we are always a work in progress and we can always and should always work to be better. Not when I say to be better. It’s not just to be better to the world, but to ourselves. Take care of ourselves a little better than we did before, period. Regardless of where we are and what we’re going through.
David Livingston, LMFT: And kind of to that end, I remember. I was a very good tennis player in college and, you know, and then I stopped playing tennis for a long time. Didn’t really play much for for probably a couple of decades. And then I came back to playing and I thought, Oh, I’m just going to kind of pick up. And I was terrible. And I couldn’t believe how bad I was, actually. And then I’m listening to this podcast by a neurologist. I think it was the Huberman podcast. It was really excellent. And he was saying, well, actually, as adults, we can learn and improve just like we could when we were younger. The problem is it’s like it’s you have to grind it out as an adult. You have to understand that the learning that takes place earlier in our life and the way our brain absorbs it can still do as an adult. But it’s far, far more effort as we’re older because the brain doesn’t just sort of soak it in. And when I oriented myself to that idea and actually decided, oh, you know what, I’m going to just work at it over time, it actually all came back and I was like, okay, well, I mean, now obviously you’re whatever age you are, you’re that age and you’re not going to be, you know, not playing tennis as a 20 year old.
David Livingston, LMFT: But but what the thing that was so profound for me is I was oriented to like you’re saying, Claire, you’ve got to work at it. I was oriented to the idea of that, that it would be the way it was earlier. And it was much harder. But once I oriented myself to that and I heard him go through the whole reasoning for that, it oriented me in a way that I was like, okay, now you just take it on and then you just stay at it. Most of the reason people fail in their recoveries and stuff is they do not persist. They don’t grind it out. They don’t figure out and keep getting the help and the things you need and stay with it until you get there. It’s the biggest reason I see people struggle.
Dwight Hurst, LPC: And it’s the other side of that realism, as we put it. Having realistic expectations really should go both ways. And you’re describing a more what we would typically think of as positive or a hopeful take on that. It’s like I’m trying to be realistic that it’s going to be hard and I have to grind it out, but also realistic about the idea that this will get I’ll get some of this back or I will develop this new skill if I keep trying and something good can happen, it’s keeping that hope. Yeah, it’s like a hopeful part of realism where sometimes when we talk about accepting reality on reality’s terms, it just sounds like going like, Ooh. I know, right? But you’re talking about an aspect of that which is also embracing the positives of our reality.
David Livingston, LMFT: Exactly. That we can learn just like we always have in our brain and our body can respond. It just may be harder. And once you orient yourself toward that. And if you take it on and you’re just going at it, right, you just you’re just working at something. And honestly, one of the things that actually is most effective in helping with any sort of anxiety, depression, so forth, is just having a trajectory of a of a future goal that you can realistically understand you can get to. And so when people are working at those things, it helps ward off all of those things for everybody. In fact, it’s two of the biggest factors that that that it helps with. So it’s when people begin to doubt themselves and give up or don’t really understand what it’s going to take. So that, you know, it’s it’s not necessarily what everybody wants to hear. But again, if you orient yourself towards it, you take it on. That in itself will give you a big dopamine hit, right? Just the process of going after something and then getting the rewards of the process of even if it’s incremental changes and improvements. There’s a whole process to that that keeps as well.
Dwight Hurst, LPC: One of the things that I was thinking about in preparation for this discussion was an aspect of self-blame. I know that I’ve met many people who, after some amount of substance use, find out that they actually have either a well, either just a physical or sometimes a cognitive impairment. I’ve known people that were like, Wow, I went to college on a scholarship and I was kind of like hot stuff. And or maybe I just was very proud of my intellect and everything. And boy, after several years of the body going through this, this abuse, boy, my brain doesn’t work as fast as it did. And I know, like you just said, sometimes that can be age. But I’ve known people even in a short amount of time that are like I struggle a lot more with math than I used to. As if a similar to someone getting a head injury. Right. And having to cope with that. The difference being someone with a head injury, often that’s a result of something outside their control. Whereas people with addiction issues, often we are trained to believe, Oh, look at me, I’m just a big dummy or a bad person. And by the way, I’ve also now injured my brain and or some other part of me. And now I’m, you know, feeling that self-blame, that self-loathing, that’s depressing.
Clare Waismann, M-RAS/SUDCC II: I think there is. There is. Yeah. There is a lot of factors there, Dwight, that could be, you know, part of why they’re feeling that way. That, again, it could be due to a certain substance like we have learned that benzodiazepines do affect your brain in ways that are irreversible…
Dwight Hurst, LPC: That’s been actually a really scary piece of research. Right?
Clare Waismann, M-RAS/SUDCC II: Correct. So, you know, benzodiazepines are more and more related to dementia, early dementia. We know that methamphetamines affect your brain cells. You know opioids. Don’t know enough yet. But with that said, alcohol. So that could be a factor. But there are many other factors I think nowadays at this time in our lives, regardless. People are overwhelmed with everything that is going on around us. You know, it is harder to focus on anything. You know, you’re continuously getting news or being aware of our surroundings. So where before you could focus a bit more on something, now our focus has to be divided in, you know, a lot of different crises going on in our lives at the same time. So I think that is always, you know, an issue that I see often now. And I am not just talking about the patient, I think, family members have that expectation that you’re going to get treated and everything is going to go back to where you used to be ten, 20 years ago, especially parents. So, you know, we I, I don’t know how much you guys see of that, but, you know, yes, they started using drugs at 14. Now they are 28, but they used to be such a nice young, you know, kid and so focused and so great in school. And parents have that tendency to believe that they’re going to get that 14-year-old back in all the experience they had for the last, you know, ten, 15 years will be raised. You know, an experience that really built, you know, who they became.
Dwight Hurst, LPC: That’s a really good point.
Clare Waismann, M-RAS/SUDCC II: Another issue.
Dwight Hurst, LPC: Yeah. That’s a really good point. I have found that when I’ve met young people who come out with their depression, let’s say they have a regrettable, like an overflow of depression, they can’t hide it anymore and then they start to get some treatment. And the interesting thing is that they’ll be doing better and they’ll get feedback from those around them that, well, I just want our happy little girl back. I just want to see that that, you know, that kid who could felt like he could take on the world. I just want to see that back. And I’ve had to have that conversation with a few people to remind them that, hey, you know, your child was hiding symptoms from you during that time where you want to. So don’t say that to them that I really want to see you happy again, like you were a year or two ago when you were not sharing and you were feeling, you know, too scared to let people know and you got suicidal and you internally were dying. And, you know, and most people, if I share that, they go, oh my gosh, I didn’t I didn’t mean to fuel that kind of of shame.
Clare Waismann, M-RAS/SUDCC II: Symptoms and experiences. I mean, that that, you know, you don’t buy illicit drugs in the supermarket.
Dwight Hurst, LPC: Yeah, that’s a good point. Well, you know, there is a whole that’s a really interesting thing to point out, too, because there is a whole like getting to know a whole different social structure, a whole different world that maybe you didn’t get to know before.
David Livingston, LMFT: Often the pursuit of drugs is towards a pursuit of feeling good or happiness. But I think a better way to think about ourselves is how about I’m authentic, have some peace and is un conflicted internally and externally as possible and there’ll be plenty of ups and downs even if we’re living if we’re leaving an authentic life, you’re just going to feel what you do. And the good news is you don’t need to worry about it so much. Eventually, you just get to have a full experience of being alive and the orientation and the ease that comes with that is to me, one of the major things that treatment is oriented to, that when people go through enough ups and downs, the different cycles, what happens is they no longer have such a preference as to how they feel. They can feel differently, they can go through this situation only things are going to happen in life we’re going to go through. It’s not that big a deal. And to me that’s one of the major goals of longer-term treatment. I don’t care whether it’s for addiction or anything. And what happens is, is there’s less preference and there’s less conflict than when you’re feeling one thing and you just feel more authentic and more human in general and it’s easier way to live.
Dwight Hurst, LPC: Do you feel like does how big of a role does vulnerability play as both facilitating that but also an obstacle? I mean, it’s kind of scary at first, right?
David Livingston, LMFT: Like, What do you mean exactly?
Dwight Hurst, LPC: I just was thinking about how that level of vulnerability to be ourselves. I agree with you. It’s a better way to live, and it’s actually more simplistic and happy to get there, to get over that hump to get there. I was just thinking that must. I think that requires a lot of vulnerability at first, doesn’t it?
David Livingston, LMFT: Yeah, Yeah, probably. But the vulnerability comes from becoming comfortable with your being ornery and frustrated and angry when you need to and still being able to have a secure attachment. I mean, that’s the hinge. I see that if people who have a secure attachment and we can just be ourselves. The vulnerability is lessened. And then that ease, I mean, that’s really the therapeutic dyad where you can sit with the therapist and just kind of show up as you are. And they will there’s a space for you to kind of come as you want. There’s not you’re not being pressured to be in any certain way. And over time that there’s a sense of that you can just be in a healthy attached relationship and be authentic and be yourself. And that is, to me, one of the core benefits of what a therapeutic relationship can offer. And but you’re right, there are moments in times, even in therapy, where there’s plenty of vulnerability, where you’re taking risks and showing sides of yourself that you’re not as comfortable with. And I think that’s just a part of development. I’m not sure any of us escape that as we get older, our ability to grow it doesn’t come as easy. We got you have to grind it out more and this is what the neurologist was talking about.
Dwight Hurst, LPC: Yeah. Because whether it’s therapy or other things or as it probably should be, therapy, some therapy and and other things to. Trying to add places and people into your life to where you can more safely become vulnerable and be yourself is kind of part of being. It’s part of getting there, isn’t it? If I’m working on being myself, I can’t make people accept me, but I can try to find the people who will accept me.
David Livingston, LMFT: You bet. And that’s right. And so, you know, that’s the idea of a good home as we get to kind of be ourselves there. And the world isn’t necessarily as accommodating always but then you can find friends and so forth and but yes, and there are still risks. I mean, you still have to, you know, show sides of yourself, I think, and get comfortable with yourself and try things out.
Clare Waismann, M-RAS/SUDCC II: David, don’t you think there’s also an issue with maturity? A lot of these patients did not mature you know, miss years and the years of, you know, that ongoing maturity. So it’s and when I say maturity, I mean regarding your own feelings. Once you remove, you know, the substance, you’re dealing with somebody maybe 27 that really is dealing and behaving like a 16.
David Livingston, LMFT: Well, that’s right. And so kind of to what you’re you’re saying, Dwight, that that you knew someone whose parents wanted them to just be that happy, easygoing, you know, 14-year-old again but.
David Livingston, LMFT: But really to grow up and to be a full person means that you can be angry and frustrated and joyful and funny. And, you know, I mean, on and on. You’re not just that simple. You’re not supposed to be. And so the process of kind of getting used to those sides of yourself again, as you’re saying, Clare, and just that development has so much to do with just getting used to ourselves in different environments with different people. So a lot of that can get sort of shut down, as you’re pointing out.
Dwight Hurst, LPC: Yeah, as I think about a conference I went to a long time ago, the keynote speaker was talking about his own experience of getting an addiction kicked up in his early life. And the example he gave I think goes to what you’re saying. He said that he was at a party, you know, just at school like a dance or something. And he was feeling so much like a fish out of water and so embarrassed and so unsure of himself that when his buddies said, “Hey, come with me”, and he brought him outside and had hidden a paper bag of some kind in the bushes outside the school and said, “Come with me, we’re going to use this!” And he never said what was in the bag, but he left that ambiguous and said, everybody has something that introduces them. But what he said was, Do you think it mattered to me at the time what was in the bag? I was depressed. I was anxious. I had problems at home. I was socially, you know, disconnected all those things and said, Do you think I cared what was in that bag? If my friend who I trusted told me it was going to help me feel better right now? And so you get back to that idea that, you know, we don’t start using just for fun like you had just said. There’s a reason behind it. And to now need a new solution for that problem is also, I think, kind of jarring because I also think people often aren’t prepared for that because then the substance is viewed as the problem, not whatever led to it in the first place. So now I have that problem and have to deal with it without substances.
Clare Waismann, M-RAS/SUDCC II: Got to start somewhere, right?
Dwight Hurst, LPC: Yeah. Yeah.
David Livingston, LMFT: Right.And childhood is hard for so many. It’s hard. So you got to make friends again and you got to, you know, and keep your life developing. But to me, to me, the thing is, if you care and you’re willing to work hard at it, you know, it’s unbelievable. And to me that’s where the magic is. I think what you said earlier, Dwight, it’s a hopeful view. If you can orient yourself and just, you know, step by step, begin to make some goals and some things that you want to do and things that matter to you and start to get to know yourself again. It’s amazing over time what can get built.
Dwight Hurst, LPC: I mean, hope is a big part of this message.
David Livingston, LMFT: It’s primary and so is courage, right? Because like you’re saying and Dwight, when you feel that vulnerable, it takes courage. It takes courage to get off of the substances. It takes courage to sort of then take on whatever felt like were limits in your life before difficulties. And, you know, it takes hope and takes courage and it takes time and persistence.
Dwight Hurst, LPC: What do you think helps people to develop that type of hope?
David Livingston, LMFT: I think it’s personal for everybody. I think other people who believe in you and just having some vision, you know, I’ve said this before, but it’s one of my favorite quotes. Einstein said, you know, imagination is more important than intellect. And I think he’s right because you have to first imagine something. If you can imagine it, then you can find some hope. And if you can imagine it and are willing to work towards it, there’s hope. That is already imbued in that process. So I think one of the things that happens that is most detrimental when people are on drugs or opioids or whatever is that their imagination shrinks. They stop imagining a life for themselves. And it’s more about it gets very, very small. And so. I know when I’m working with someone, one of the things I really do is I try to sort of evoke and find out what they want for themselves. And it’s often one of the most difficult and painful things for them to answer. And sometimes it takes a while because it’s scary to hope again and vulnerable like you were saying. So but I think I think once you can imagine something then and you’re willing to work at it, then I think hope begins and comes along.
Dwight Hurst, LPC: We’re going to call it there for this conversation today. But we’ll be back again soon. What should we talk about? Well, I’m glad you asked. You can email us at [email protected] to ask us your questions about mental health treatment, recovery, the addiction detoxification process, or any of the things that we talk about here on the show. Clare and David and myself are lined up ready and willing. The music used in the episodes is the song Medical by Clean Mind Sounds. This episode is released by Waismann Method Opioid Treatment Specialists and Rapid Detox Center and produced by Popped Collar Productions for Clare Waismann and for David Livingston. I’m Dwight Hurst. Remember to keep asking questions because if you ask questions, you can find answers. And if you find answers, you can find hope. Thanks again for listening. Talk to you soon.