Opioid dependence can harm both physical and mental health in complex ways. Overcoming this dependence offers a chance for long-term improvement in both physical and mental health, as substance abuse affects both the body and mind. However, it’s important to understand that the two are interconnected and cannot be treated separately. Ignoring this connection can lead to serious consequences.
Dwight Hurst, LPC: Welcome back to Addiction Recovery and Mental Health, a podcast by Waismann Method Opioid Treatment Specialists. I’m your co-host, Dwight Hurst. Proud as always to be paired up today with David Livingston and Clare Waismann. We are here to answer your questions about addiction treatment and opioid dependence. All right. So our question today is, is quite intriguing, I think. And David, you had brought this up, but the subject we were going to address today was learning the difference, to recognize the difference between physical and psychological challenges – and you had specified both – while someone is using drugs, but then also during the detoxification process as well. There are these different effects and, you know, how do we tell the difference and what are important differences? How am I doing with summarizing what that topic is?
David Livingston, LMFT: Good. Good. Well, good. And maybe we’ll just kind of explore it in our own ways like we normally do. And. But that’s good. You know, I think that what I was thinking about is that and I think this is not only for people who are who are dealing with wanting to come off a substance and the effects of being on it, but also what they go through kind of in the process and then afterward and there’s both physically and then emotionally and there’s there’s, I think, predictable stages. And so and I think it’s also important, you know, for the people who are their loved ones, family, friends and so forth to maybe understand it too, is a way of kind of having some insight into what the person may be going through. So if you’re coming off of opiates or you’re on opioids, you’re especially if you’ve been on them for a long time. So, so often we when people when someone’s been on an opioid for a long time, what they begin, there’s this phase that is reported to me consistently where someone will get on an opioid and they feel better. Okay. And particularly with people who tend to struggle with dependency, they often feel more effective at everything. There’s not a lot of downside in the beginning, despite all the profound dangers that there are right now. They feel better then that ramps up for a while and they kind of peter off and they’re just maintaining.
David Livingston, LMFT: And then it goes down the other side where they start to shut down. They show no interest or little interest in things they were once interested in. Their metabolism is processing the medications so quickly that they are in and out of low levels of withdrawals. Sleep is often disrupted a lot and they become very anxious and sometimes they’ll even see things like suicidality kick in. You’ll see things like just a type of desperation. So that’s kind of a path of it from a physical. And in some ways, the emotional tends to follow, as I’m describing as well,
Clare Waismann, M-RAS/SUDCC II: Your body’s connected to your head. Then there is, you know, an association with how you feel and how your body reacts to it. If you don’t get a good night’s sleep, your day will be disturbed. Your energy will be disturbed. If you don’t eat a nutritional meal, you know, your gastrointestinal will be disturbed. And again, you know your energy and how you feel. So there is a whole connection of body and mind and you can’t separate it and you can’t always pinpoint to a certain symptom like, you know, I am craving or I’m still detoxing. Sometimes it’s just a bit of each or none of the above. And it’s truly your body trying to regulate and find a new baseline, learning how to work without that drug that has completely disturbed every function.
Dwight Hurst, LPC: Yeah. It’s interesting what you say. We often do make a delineation between physical and mental, but yet, as you say, the brain is contained in the body, Right? It’s an organ of the body. And so it is it’s all related. It’s all physical in a way when you have that. I think one of the differentiations we often try to make is, well, let me say, outside of the field, outside of the field of therapy and treatment and substance abuse, oftentimes when people say something like, well, is it physical or is it just psychological? One of the big problems with that is people hear, well, is that real or is it fake? Right? I mean, that’s what people think of people with chronic pain. A lot of them will tell you that it takes a long time to get any kind of diagnosis or be taken seriously if it’s not easy to find the source of the pain. Right. Because then we say, oh, that’s where they start hearing people say, well, maybe it’s psychological and it might be psychosomatic or psychological. But the way that’s presented, oftentimes people interpret it as, Oh, you don’t have a real problem, you’re just kind of making it up and you should go away.
Clare Waismann, M-RAS/SUDCC II: And so you can’t dismiss how people feel. Yeah. You can’t just disregard because even, you know, if it’s coming from, you know, an emotional part of the being, they’re still feeling it. So you can’t just disregard it as it doesn’t exist.
Dwight Hurst, LPC: Yeah. And that’s oftentimes the problem.
David Livingston, LMFT: That’s right. Well, that’s exactly that. Just because we don’t understand it yet doesn’t mean that it’s not real and it’s real for them. And, you know, in my experience. Just like you’re saying, Claire. I mean, people don’t report things that they’re not feeling. It’s a waste of their time. So, yeah, it takes time sometimes to differentiate. But one of the things that’s profound about opiate use, especially for people who tend to struggle with developing the dependency, is when they start it, they often feel more energy and, you know, and a cessation of anxiety or depression or even pain. So that it triggers to the brain and the rest of the body this is good for me. And, you know, because, you know, and it creates a sense of well-being because, you know, generally one of the causes of happiness in reality, just like you’re saying, is like, so if you sleep well and you eat well and you exercising well, you get more energy and you get the endorphins and you get a sense of well-being that tends to sort of come with that. And so opioids can mimic that where people get energy and have a cessation of pain. So it’s a false read, but the brain reads it and remembers it.
David Livingston, LMFT: So it’s. Until they go through the whole course of it, because eventually, that will end. And with fentanyl and everything, it’s incredibly dangerous. But so I’m not advocating that. But I’m saying it’s one of the things that’s confusing about the early phase of it. And so any rate, and one of the things that often people remember. And not remember all the other sides of it, which I’m still trying to figure out. Why the brain remembers what is positive in this case far more than it remembers all the negative because generally it’s the opposite. Usually, when something scares us or frightens us, we remember that far stronger than we do. Something that is that made us feel good. But it doesn’t seem to be the case always with this.
Clare Waismann, M-RAS/SUDCC II: The rush of dopamine is far greater than anything else, any chemical in your brain when you use opioids. So you know, you tend to remember what you felt the most. And that is pleasure, you know, is that euphoria. And I think that’s why, you know, a lot of the negative consequences are not as remembered I wouldn’t say forgotten, but as remembered, because the euphoria and intense feelings of pleasure are so much greater.
Dwight Hurst, LPC: That’s a that’s an interesting thing.
David Livingston, LMFT: You just explained.
Dwight Hurst, LPC: It. Yeah, exactly. Especially when those who are seeking after, like, some form of self-medication and we you know, we talk a lot about that, how addiction really is very connected to self-medicating. And so if I’m reaching out because of a need that I have and I don’t know how to appropriately medically treat it, one of the things that’s going to happen is it’s going to feel pretty good at first, right? You know, it’s going to feel like I find not just like good as in pleasurable and enjoyable, but good as in, you know, where has this been all my life? Like, hey, maybe I’m finally feeling better for maybe the first time if I’ve never, you know, either if I’ve never found another way to feel better from a problem, Right?
Clare Waismann, M-RAS/SUDCC II: Think about it. I mean, the effects of the drug itself in the body, you know, it blocks all pain signals and releases large amounts of dopamine. So it’s. If you didn’t have all the, you know, addiction, dependence, tolerance issues, it’s a pretty great drug. You can eliminate, you know, the bad and emphasize the good. It would be pretty great if there wasn’t. You know, again, the long-term consequences.
Dwight Hurst, LPC: Yeah. If we didn’t have the long-term consequences, probably everybody would just be doing it and it wouldn’t be a problem.
David Livingston, LMFT: Right. And a longer-term treatment, one of the things that you begin to understand that everything in life, everything is a dynamic as you begin to remember and understand opioids as a dynamic, as the good and the bad. Right. The part of it that’s helpful, the part of it that’s also very, very dangerous, especially right now, which I don’t think you can emphasize enough. But but you’re right, over time, you can keep the fact that life is dynamic, right? We feel good and we don’t feel good. We’re healthy at times and we’re sick at times in our body works the way we want and sometimes it doesn’t. And on and on with everything, really. And so I think that becomes sort of the basis for understanding yourself in life. It’s easier to keep everything close together and make good decisions. It’s when those things get too separated that it’s hard. You don’t really remember closely enough. Like it’s a dead-end street.
Dwight Hurst, LPC: I remember being at a training one time where a representative of the company that makes Suboxone came in and he was talking about some research that they’d had into those. And we’ve mentioned Suboxone on the program. If anybody out there doesn’t know, it’s a oh, gosh, you guys don’t know the word better than me. Antagonists a certain am I, right?
Clare Waismann, M-RAS/SUDCC II: It’s actually an agonist is exactly the opposite. Yes. It’s an opioid so it has an antagonist in it. But um, the ingredient that people are looking for is the agonist because is an opioid and is a medication to replace another opioid.
Dwight Hurst, LPC: Yeah. Yeah. Yes, exactly It’s.
Clare Waismann, M-RAS/SUDCC II: Keeps people from withdrawing.
Dwight Hurst, LPC: Yeah. And it Yes. Thank you. I appreciate that. And it can be a lot of help to people who are getting off of opioids and other than to avoid the withdrawal pains and some of those things that actually will delay sobriety for a lot of people. But he was saying, though, that when they’ve done some research into this, they found that when you get below a certain dosage, because oftentimes the treatment recommendation is doctor, therapist, whoever, whatever treatment team will work with the client and help them to titrate down. And eventually, the goal is to get off of Suboxone. Right? Usually. And so when you get below a certain dosage, it’s actually not treating withdrawal symptoms anymore. In fact, if you get below a certain dosage and you’re not having withdrawals, my understanding is it’s basically, you know, you don’t have them anymore. You’ve gotten to a point where you have withdrawn completely. But he said people will be stuck on that lowest dose because there is some evidence that it actually helps anxiety just a little while going completely off of the medication tends to raise anxiety. And so there’s this natural sticking point where people get and that’s one of the first things is that memory came back to me when you were talking about the physical versus psychological effects. Right? At that point, I’m only treating a psychological thing. I’m no longer treating withdrawal symptoms because I chemically and physically don’t have any anymore. Right.
Clare Waismann, M-RAS/SUDCC II: Well, but then I think we get back to that point. You know who came first? The egg or the chicken? So is the Suboxone masking an anxiety issue that existed in the first place?
Dwight Hurst, LPC: Oh, right, Right. Does that become its own problem? Right.
Clare Waismann, M-RAS/SUDCC II: Exactly. So, um, and trust me, we treat patients on very, very small dosage. And you have to remember that anxiety is also. A symptom of withdrawal.
Dwight Hurst, LPC: Yeah. That’s a good point.
David Livingston, LMFT: A major symptom. And and I think that Suboxone clings so hard to the receptors that, yes, it is that last that list, that last little bit, that is very, very much the whole detox for most people. Yes. So it’s unlike regular opioids where you can only titrate down and wean off to a certain degree before you’re in significant withdrawals. You can go way down often on Suboxone. And then the last bit of it, because of how hard it clings to the receptors, is, is significantly the detox itself. So it’s it acts very differently chemically. Unfortunately, you know, and I speak you know, I have long talks with my son that is studying psychiatry. You know, unfortunately, most of these studies have a secondary goal. In most cases right now, they’re saying that Suboxone can be a long-term or a life-long prescription. So on small dosages. So, again, you know, when you when you hear these studies made by pharmaceutical companies regarding their own drugs, there is usually more to it.
Dwight Hurst, LPC: Probably. Yeah, that’s probably that’s a good point. You probably do want to kind of look around some of that information, don’t you, If it’s like, Hey, you should. I’m just picturing if someone’s like, Hey, how do you think I’m doing in therapy? If I was to say, you should just come forever. That doesn’t seem very. Yes. Yeah.
David Livingston, LMFT: Because, well, there’s a there’s, it’s, yeah. And it’s not just, there’s, there’s a and I know this having talked to hundreds and hundreds of people that we’ve gotten off of Suboxone, what I hear consistently reported to me is that yeah, I was fine on it for a while and then all of a sudden my body couldn’t tolerate the drug. It’s as if your body at a certain point in time almost starts to reject it. I mean, I can speak for a long time as to the variety of ways that’s been reported, including feeling like, you know, it felt like I was taking a toxin. And every time I start to get nauseous, I would have anxiety. My anxiety started to go through, so the body over a period of time. You see this with a lot of medications. It’s not just Suboxone or eventually, you know where the body no longer responds the same way it might have in the beginning. And sometimes that happens quickly with people. Sometimes, you know, people don’t like it to begin with. And sometimes people can be honest for a long time before that happens. But I hear that consistently. Yeah. Hmm.
Dwight Hurst, LPC: And do you think that this is, you know? Oh, go ahead, Clare.
Clare Waismann, M-RAS/SUDCC II: That’s okay. I heard something yesterday, you know. A quote that… It’s related to what we’re talking about. You know, it said that “People do not decide their futures. They decide their habits and their habits decide their futures.” And I think it relates to what we are talking about, you know, whatever we do daily is pretty much deciding our future for us, you know? So when you were taking a long-term drug, that is going to change the way your brain functions and is going to put a blanket between you and reality, between you and your emotions, between you and your pain. That is part of your happiness, that habit is deciding your future, and how your life is going to be.
Dwight Hurst, LPC: It’s a good point. You know, it’s a good point to think about when we’re in here. And it strikes me as you’re both talking about this, how we tend to overfocus. One of the things that can be problematic when we’re trying not to do drugs is to spend too much time thinking about drugs. Right. And over obsessing and type of thing. And one of the reasons for that is, is we’re focusing on the physical and now occurs to me we’re focusing on the chemical dependence only. And then the psychological component of why was I self-medicating, What am I shielding myself from? You know, am I getting any better at that element? Because as you were saying that’s the underpinnings of the addiction?
David Livingston, LMFT: Well, that’s such a fantastic statement about habits and how they decide our future. It’s how we feel and who we are should be something that we get to sort of discover and then create habits that are healthy and helping us sort of do that. And the process of dependency in some ways limits that, you know, if it becomes too strong of a habit. So it’s worth thinking about the way you put it, Clare was fantastic. So we’re talking about kind of the process of being on the drug. Maybe should we talk? Do we have enough time to talk about kind of what it is to get off of it? And so…
Clare Waismann, M-RAS/SUDCC II: And David, if you can talk about discomfort as well, you know, the importance of feeling that array of symptoms, of feelings, good feelings, bad feelings, you know, having something to compare to feeling life on life’s terms, period. I use this language and some people don’t like it. And, you know, I can kind of understand well and understand why. But you might say that there’s an adult and it’s all in a baby and it’s all okay. So the baby part of us wants to feel good, doesn’t want to care too much, wants to be relaxed. You know, its primary concern is feeling good. And part of what you’re talking about, Clare, and creating healthy habits, is an ability to sort of let the adult part of us be in charge.
David Livingston, LMFT: And with the idea that we also need to feel good, we need to relax, we need to forget about things. And that needs to be a part of it. When you want to get off of a substance, it is primarily a moment for the adult part to kick in and say, okay, this is what I need to do. And, you know, the feeling good part comes later and it comes down the road, but it comes. And so it’s that whole idea of being able to tolerate ambivalence, being able to make it through periods where things are harder, but it gets you where you want to be. And I think that’s the approach that you take. And any time you’re going to take on something, that’s hard. Is that what you’re talking about, Clare?
Clare Waismann, M-RAS/SUDCC II: I am. And I’m not talking just about the. The patient themselves. I’m also talking about the family. You know, you get those calls, you know, three days after a patient is home or something. “Well, they’re not feeling great. You know, “This morning he woke up and had a bit of a stomachache. His back is hurting”… It is you know, and I’m constantly saying, doesn’t your back hurt once in a while? Don’t you have a stomach ache once in a while? Do you know? Do we have to medicate everything we feel? Did the stomachache or the backache feel better after a few hours? “Yeah. In the afternoon. He was fine.” There is that expectation that life has to be great without any discomfort, any pain, any unwanted feelings. And that’s not reality.
David Livingston, LMFT: Well that’s that’s, that’s right. So that it’s not just the patient, but it’s confusion of the people around them, you know like like a lot of what. And creating an accurate perception of what you’re going through. Right? So like I’m saying, it’s you know, it’s a period of time where your body is going through a lot of readjustments. And so there’s going to be discomforts, there’s going to be some dysphoria, there’s going to be some dysregulation as your body kind of comes back into itself. Doesn’t matter. That’s just an inevitable part of the process.
Clare Waismann, M-RAS/SUDCC II: But isn’t that always in life, though? I mean, obviously more as you are recovering, But isn’t that something that somebody because I think not just of our treatment, but with treatment in general, recovery in general. No. There is an expectation that you know, life is going to be just great.
Dwight Hurst, LPC: And I think unless we know to address it right, like you say, so many times, people don’t take the time to go over that with a patient. Right. And say, hey, this is what you can really expect realistically. And here’s some parts going to be very, very hard. Some parts are going to be harder than when you’re using, as a matter of fact, and some are going to be much better. But that’s just that’s we’re replacing some of the good and some of the bad that you’re experiencing now, because some of the good and some of the bad you’re experiencing can kill you right now. And so trying to adjust that accordingly, you know, and once again, having it all within this treatment mentality, I think instead of the mentality of, hey, you know, you’ve misbehaved and now we’re going to and that kind of goes back to the core of, I think what the question that you’re bringing up, Dave, is that feeling, that feeling of we’re approaching it from this purely like external physical standpoint and not the psychological right saying just knock it off and the person, even if they manage to to cold turkey for a while or even if they manage to stop for a while, but they don’t address their psychological and emotional health or as you’re saying, clear their own expectations. And if those don’t ever adjust, then the problem really has never been really we could call it treatment, but it hasn’t totally been a treatment yet at that point.
David Livingston, LMFT: Well, I think that’s it. So just to use this concept again. So the experience of a baby and and even, you know, as were which is, by the way, the core of dependency, our first experience of dependency happens is as we’re infants for everybody. And the experience is when we have a feeling, okay, the experience of that baby part of us is it’s interminable, meaning there’s a part of us that thinks it could go on forever. So the reason that a mother or father, a caregiver comes in when the baby’s crying is to give it an experience of something outside that can soothe it. And then it takes that feeling away that it’s going to be interminable, Right? That it’s never going to end. So what you see a lot when people are coming out of this is almost like a panic like that. Like, oh, my God, I got a stomachache. Well, and so you have to soothe it by correlating it to you remind them, “Oh, well, look what you just went through”, and “Oh, how’d you sleep last night? Oh, I didn’t sleep well last night?”, “Have you been feeling better?” “I have been feeling better.” So all of a sudden, there’s this understanding that you begin to correlate and the thinking part of the individual comes in and they have some context, and that itself tends to be the soothing mechanism. So I mean, that’s certainly part of what I do and what we all do and differing ways, but.
David Livingston, LMFT: But otherwise, you can begin to feel like. And the parents can also do this. “Oh, my gosh. He’s he’s weak or she’s feeling tired. And, you know, how long is this going to go on for? Well, you know, as soon as you’re sleeping well and you’re moving around and your body will begin to adjust. And and usually there’s there’s nothing concerning going on. There’s just a feeling that things are going to go on forever or a fear of it, I should say.
Clare Waismann, M-RAS/SUDCC II: Yeah, I guess maybe I’m a little more radical than you guys. I see it more like, you know, the learning, learning to heal and being patient about it. You know, I had a headache an hour and a half ago and I took some Tylenol and it took around 40 or 50 minutes. And you know what? I’m feeling much better right now. So I am happy that I’m feeling better. So I’m not upset that I had a headache. Do you understand what I am saying to you? I think that’s what I try to speak to parents of all the time, having a backache, waking up in the morning and taking a shower and moving around so that backache, you know, gets better. It’s actually a good thing. It is a healing process. It doesn’t necessarily need to be the best feeling, but a good feeling that I am. Every day. Whatever stones come my way, you know, I jump over it, then I get better. So that’s a good thing. A good thing? Yeah. Does that make sense to you guys?
Dwight Hurst, LPC: Yeah, I think…
David Livingston, LMFT: That’s exactly right.
Dwight Hurst, LPC: David, do you think this is where those two elements meet? The what we call the “physical” and the “psychological”? Do you feel like that’s one of those areas where it’s important to see and work with the aspects of both?
David Livingston, LMFT: I do. That our physical body… You have to understand and I know this is kind of a different way of thinking about it, but we have that that baby part of us exists in us forever. So we need something from the outside sometimes that is well correlated, that’s attuned to what we’re needing on the inside. So, Clare, you needed to take a Tylenol and you’ve, you know, and so your patient and you could recognize that. And so a lot of what happens is that when people don’t know what they need or aren’t sure how to get it from the outside, there’s this feeling or this panic almost like things are going to go on forever. And so once that is correlated to something that they can do, you know, like you’re saying. And that’s where the idea of habits is just so profound. Once you begin to know how to take care of yourself through good habits, it’s almost just, you know, you have a life that’s just kind of rolling through that process, just probably something we all need to do. Not probably we do.
Clare Waismann, M-RAS/SUDCC II: Yeah. We’re just human. That’s. That’s all it is.
David Livingston, LMFT: That’s all it is. As complex as that can be at times.
Dwight Hurst, LPC: Thank you so much for being here and listening. We’re going to call it there for today. Lots of important tips, lots of wisdom that I was glad to be a part of in this conversation. If you’d like to get involved in our conversation, please email us at [email protected]. Or go to opiates.com. You can tweet us @opiates on Twitter or any social media and tell us questions that you’d like us to address on the show. We’re excited to hear from you. This podcast is a production of Waismann Method Opioid Treatment Specialists and is produced by Popped Collar Productions. Our music is the song Medical by Clean Mind Sound. Please consider leaving us a five-star review on Apple Podcasts or your podcatcher of choice. It helps people to find the show or go out and tell a friend about the show today. For Clare Waismann and David Livingston. I’ve been Dwight Hurst and glad again to have you with us. We’ll be back in your ears soon. Until then, keep asking questions. If you ask questions, you can find answers. And if you find answers, you can find hope. Thanks again for being here. Bye-bye.