Walking or running away from substance abuse is never easy.

Opinions differ on the best method to become clean.

Experts agree that sobriety is work, a lot of work.

The brain does get better, but it is not an instant fix.

Elaine Stano, a treatment specialist for the Fayette County Drug and Alcohol Commission, said the problem is that transition period — people don’t know what to expect.

“They think the acute withdrawal is the problem,” she said. “Once they are through the acute withdrawal, everything else will be gravy. But that’s not what happens. They go through maybe months, depending on what they use, where they really do have to struggle to wake up in the morning and say, ‘Thank you, God, that I’m here.’ They got to struggle for that. It takes time.”

William Addis opened up about his life at a summit hosted by the Fayette County Drug and Alcohol Commission earlier this year. Addis said he was a longtime addict who was hooked on heroin, among other substances, but he has since become clean and sober. He is attending California University of Pennsylvania and attending church regularly.

Addis advocated a “cold-turkey approach” to curing his substance abuse problems because he said prescribing drugs to an addict doesn’t change the behavior but perpetuates the problem.

“I’ve seen people that come out of these clinics every week where they get prescription drugs, and it doesn’t solve anything,” he said in an interview following the summit. “I tell these people, ‘This is not going to work for you. It didn’t work for me and others.’ Usually what ends up happening is they go back to the streets. If I see them again, hopefully, the point has been made, and they will listen to what I have to say about how to steer clear of drugs.”

Drug and alcohol counselors were very familiar with Addis’ story and his approach to sobriety. While not dismissing his approach, counselors said that’s not the only way for an addict to regain control and stay sober.

“You can’t ask one addict to talk about the experience of addiction and hold them as an authority because they are an authority for their experience — not the entire field,” said Erica Usher, a prevention supervisor for the commission. “You have to take what Bill’s saying, and I have the utmost respect for him, that swapping one thing for another — but for many people, that’s what helped them be successful. The trick in our field is that we don’t know. We can look at someone and say, ‘This is what’s going to work for you; that’s not what’s going to work for you.’”

When the party ends

By anybody’s definition, stopping cold turkey is not easy. Though coming down depends on the drug of choice, enduring the aftereffects is no party.

“When you wake up in morning, you are not feeling the psychological, you are feeling the physical,” Stano said. “You are sick. Your body hurts. The physical is very pronounced, that’s why most people don’t pay attention to the psychological aspect of addiction because the physical aspect is so pronounced, especially with opiates.”

Detox is an often painful experience where the chemicals leave the body.

“Alcohol can be pretty bad itself, but with opiate addiction, the entire body is addicted. So when you stop taking opiates, every inch of your body hurts. And that’s how addicts describe it,” Stano said. “They’ll say, ‘My hair hurts all the way down to my toenails.’ Oftentimes, after the acute withdrawal is over, the post acute, which is the periodic pains or breaking into a sweat or a bout of anxiety, kicks in. Post-acute withdrawal symptoms seem to linger a long time after somebody has stopped using.”

Then the mind starts talking, and for someone coming down, the whispers within become shouting — irritation with everything and everyone. As the days wear on, there emerges a gray existence like a cold, cloudy November day — a place and time where there is no joy.

“The psychological is probably more noticeable when you are actually trying to move away from the use of the opiate,” Stano said. “It is hard to describe. When you take an opiate, you have a sense of the world is OK. ‘I can take care of anything. I’ve got all the confidence in the world. I have energy. I can fly through the day and do whatever I have to do. I don’t have to worry about being irritated with my boss or co-workers — I can deal with that.’ When you take away the opiate, everything is 10 times worse. ‘I don’t feel like doing anything. I don’t feel like getting up. Everything irritates me. I find no joy.’”

People spend more and more “Time in a Bottle,” as James Croce sang, because the alternative is not easy as taking a yellow brick road to better place.

“After you get through the acute withdrawal, now you have deal with — ‘I don’t have much energy. I don’t have much motivation,’” Stano said. “That goes on day after day. People get frustrated and they say, ‘You know what, if this is the way I have to live without drugs, I might as well live with drugs.’” It can take months to effectively get off some of those drugs.”

Anhedonia – aka sober town

There is a time within withdrawal known as anhedonia, a place where happiness fades from existence.

“Everybody will go through anhedonia when they go through withdrawal, but opiate addicts especially go through this. That means lack of pleasure. They can’t get happy about anything,” Stano said.

People discover that though this is not the way they want their story to end, anhedonia is a hard place to live.

“We keep insisting that they should be grateful that they are clean; grateful that their life is back on track,” Stano said. “But what you don’t understand is that they don’t feel good about anything. They are grateful that they are not using, but they don’t feel good. Imagine what that feels like to walk around all day when any of the things that gave you a little bit of a smile — you don’t smile with that any more. That is a hard way to live.”

After, the party is over when addicts try to find the people they once were.

Melissa Ferris, assistant executive director for the commission, said therein lies the methods and means to stay clean because an addict, whether high or sober, is always an addict.

“It’s the nature of the disease,” she said. “You want to get people clean and you do everything you can but sometimes something happens when the client is doing really really well and the client is no longer in treatment. They can’t cope. Then they start using again.”

Stano said it takes time for clients to learn how to change and manage their lives so that they can make the changes necessary to deal with recovery. She said more than 50 percent of the people undergoing treatment go right back to their addictions, so they go through the cycle again. People always remember the good times, not puking in a gutter or that wicked hangover.

“I always say to addicts, ‘Don’t you remember how sick you were?’” Stano said. “No, the brain doesn’t remember. It doesn’t have you focus on the pain. The brain is going to have you focus on the pleasurable events. You move away from all the chaos of the addiction. And you are sitting here a year later, let’s say. What comes to your mind? Not that you were sick and puking in a toilet — what comes back is ‘wow, I had all that energy. I could clean all those things.’ Then you think, ‘I have all this stuff coming up.’ You say to yourself, ‘if I take just one pill, just this one time.’ Before you know it, they are back in the cycle again.”

Methods to save lives

Counselors use a variety of methods, including prescription medication, to treat the effects of addiction.

“Professionals in this field have to have a variety of tools in their tool box to throw out whatever is going to work, what’s going to stick, what’s going to be successful for you.” Usher said. “Our goal is to make sure that people aren’t dead. If we’ve prolonged your life because you were in a recovery for a period of time, you relapse and we try something else, then you’re not in the gutter. We’ll take that as a win because you came back.”

Stano said recovery is just as much a belief as it is an action.

“When somebody initially gets addicted, they have no idea what they are up against in terms of moving away from their chemicals. They, just like the rest of the world, believe that all that is required is that you move away the drug by stop using and you will immediately go back and live like you did before. Everybody believes that.”

Methodone and suboxene are used to treat heroin and opiate addictions. Addis might say that treating a drug with another drug doesn’t solve the problem, but perpetuates the cycle.

“The idea that you can present to someone who uses as much drugs as they can get their hands on — ‘here is your little bit of drugs for today — now run along and be normal.’ That’s kind of crazy,” he said. “But that is the mentality and the mindset in much of the medical and treatment community today.”

Usher disagrees.

“So to say that methodone is prolonging it — that may be true for some people — but I’m unwilling to say, ‘let’s throw that out’ because for some people, that’s what saved their life,” Usher said.

Ferris added that maybe those drugs may save a life.

“Maybe that’s what’s keeping them from buying heroin on the street, shooting up and overdosing,” she said. “Medication has its purpose for some people. Some maybe can just stop cold turkey and they are fine. Other people might need to go to an inpatient facility to detox and go to rehab. Other people they might need suboxene or methodone to get them to a point to detox them off.”

Bill Miller, driving under the influence supervisor for the commission, said by offering prescription drugs among other means, a person is able to buy time so that when they truly get to that point where they have to quit, they are ready. That’s why every means necessary is on the table.

“They’re going to fail,” he said. “You’re going to fail, you’re going to relapse. But you don’t know at what point that you’re going to say, ‘now I’m ready. Let’s get it done.’ That’s going to occur with each patient. It’s just like anything, when you want to take charge and do something about this, that’s where you change.”

No magic bullet

People have been trying to lose weight for years, but an obesity epidemic is still growing.

Put simply, if people can’t stop overeating, what makes anyone think they can cure drug and alcohol addiction?

“What’s the magic bullet for obesity?” Stano said. “Tell me, what pill is out there, what diet, what program out there has been able to reduce our obesity rate? We can’t even fix weight gain, so do you think you are going to fix addiction?”

Stano said curbing addiction is about changing behavior.

“It’s about behaviors, about people and about feelings,” she said. “There is no easy way to address all of that in just one simple way. There’s just not.”

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