From Dr. Mel Poh'ls book Pain Recovery...

Why are the words “addiction” and “addict” so problematic for so many people? Much of this difficulty can be attributed to the stigma that is assigned to them. Merriam-Webster’s Collegiate Dictionary defines stigma as “a mark of shame or discredit.”* It is often attached to social judgment and cultural norms. The stigma attached to “addiction” and “addict” makes them “dirty” words. Despite volumes of research on drug dependence and scientific evidence to the contrary, addiction is viewed by many as a moral failing or weakness. Addicts and their families are subjected to social, legal, and financial discrimination, making it difficult for them to obtain the help they need. When addicts do access help, insurance is inadequate to cover the cost of effective treatment. Family members are often the most judgmental because they have experienced the consequences of the addict’s behavior, not realizing the addict is sick, not “bad.” 

Addiction is one of the few diseases that carries such a negative emotional charge and is a source of shame or embarrassment. Who would want to have a diagnosis or label that carries such a stigma? For those with chronic pain who take opioids, attempting to discuss this topic is often met with resistance and denial.

Usually people begin taking medication to manage physical pain, but at some point, often without realizing it, start using the medication to manage emotional pain as well. Eventually the medications no longer work for long or very well to ease the physical or emotional pain, and the side effects may actually cause more physical and emotional pain. This happens because long-term use of opioids can increase the body’s and brain’s pain signals. This is called pain rebound syndrome or opioid-induced hyperalgesia. In the end, medication use that started as a reasonable treatment approach to relieve suffering can be the cause of problems in all areas of your life.

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From Chapter 2 of Tails of Recovery by Nancy A. Schenck...

My name is Frank, and I am an addict. I am clean and have been in recovery for twenty-one years.

Writing this is bittersweet. It entails recalling the two most painful circumstances I have ever experienced. In fact, even as I write, my grieving process is less than thirty days old, which makes it all the more difficult. But I have a story I think needs telling.

My story describes the depths of degradation into which untreated addiction can take someone. It is also a beautiful tale about healing, the redemption of a tortured soul, and recovery from the disease of addiction. This is a story about me and a dog named Rasputin. My wife, Teri, and I were forced to put Rasputin to rest two weeks ago to free him from the agony of terminal cancer. His life and death have had a profound effect on my life and recovery from addiction, and that is part of this story.

I have learned in recovery that when circumstances cause you pain, it helps to try and find a purpose in them. Telling this story and saying goodbye to my beloved friend Rasputin is part of my healing process.

My story began in 1983 when I was living in Las Vegas with my girlfriend and her two young children. We had recently moved to Southern Nevada from Chicago because other members of my family were moving to Las Vegas. It seemed like a good ideas since my addiction was out of control and I was having problems with the police.

I believed at the time that moving was a way to get a fresh start with a ready-made family. I loved my girlfriend and her two young daughters with everything I was capable of giving at the time. I was ready to build a new life, get married, and adopt her girls. Her daughters’ fathers were out of the picture and living in their own addictions and I was more than ready to take their place. When we first moved to Las Vegas, we lived with my parents for a year until we could get on our feet. Then I got a job dealing craps, and we moved into a small apartment.

When we moved into our apartment, I became obsessed with getting a bull terrier. I saw one in the movie “Patton” and was soon poring over articles I found in magazines and reading library books about dogs. At the time I thought my addiction was manageable, meaning I was in a “partying” stage. Although I was starting a new life, I didn’t think it a problem that I was drinking at the bar after work for three or four hours while my girlfriend waited in the car with the kids. That’s part of the nature of addiction. It can cloud and mangle a person’s thoughts and actions until up seems down and right seems left.

After seeing the dog in “Patton,” I decided I had to have one. It didn’t matter that we were living in a small, two-bedroom apartment that was going to be a terrible home for a dog the size of a bull terrier. I was thirty years old and never had a dog. Although I always wanted one, my parents would never allow it. I remember hearing so many times, “When you move out and get married you can do whatever you want, but we are not getting a dog.” I wasn’t married, but I was going to do what I wanted when I wanted.

There were no bull terrier breeders in Las Vegas, but I found one in Pennsylvania. When I contacted the breeder by phone, I assured her I was ready for a pet and was very responsible. I lied and said I lived in a big house with a big back yard. I wasn’t going to take the chance she wouldn’t sell me a dog, because at that point I had to have one. She said she had a puppy that was six months old, but added it would probably be better to wait for the next litter. She thought a younger dog would be a better option for me.

There was no way I was going to wait. I was obsessed and wanted a dog “now.” Today, when I look back, I can see I was deep into my addiction. I was very manipulative, as most addicts are. The only thing that mattered to me was to have what I wanted when I wanted. I finally convinced the breeder that I was a perfect pet owner and she agreed to sell me an animal. I spent $1,000 for the dog and the airfare to fly him to Las Vegas. It didn’t matter that I was just starting out with my new family and really could have put the money to better use. As in many situations in my addicted life, I didn’t have a plan and I had no idea of what I was getting into.

I was working the day my new bull terrier flew into Las Vegas. He was all white with a brown spot over his left eye. The breeder had named him Rasputin because she thought he resembled Rasputin the mad monk with the evil eye. My girlfriend and my dad picked him up at McCarran International Airport, and it was a disaster from the outset. Rasputin was already six months old and fifty pounds of solid muscle. He had pooped inside his kennel on the plane, and he was an absolute mess. Rasputin was too much for my dad or girlfriend to handle. When I came home, my girlfriend was furious from having to try to control my dog. He was running in circles throughout the apartment and knocking over everything in his path.

I tried my best to teach him to behave, but I didn’t know a thing about dogs or training them. Like most of my life in active addiction, my intentions were good, but things usually went wrong. I loved Rasputin from the moment I saw him although my ability to love was based on a closed heart already damaged from many unresolved childhood issues, failed relationships, and simply not knowing or understanding the disease I had. In other words, true intimacy was not part of my life.

I quickly brought a trainer into the picture. That cost another $2,000, further burdening my family. I had to manipulate my girlfriend constantly to get what I wanted. Everyone was paying the price for my impatience in not waiting to get a dog.

The trainer did his best, but even he had a difficult time trying to get Rasputin to comply. The dog was already set in some ways and incredibly stubborn. By the time the trainer was finished, Rasputin wasn’t fully trained, but I had learned many of the tools I would need to finish the job. Follow-through, however, was not in the cards.

All those years ago, I felt like I wanted so much to be in control of my life, but in reality, my priority was always more drugs. I was using more and more and the impact was terrible. I wanted to train Ras; I wanted to be a good father; I wanted to have a healthy relationship, but I didn’t have a clue how to do it. And as long as I was deep in my addiction, I would never learn.

I tried to finish Rasputin’s training, but I was inconsistent and didn’t give him a chance to succeed. As much as I loved him, I found myself getting more and more frustrated and angry. My corrections became harsher, and I would come home from work to find the destruction he had done for the day and it would drive me crazy. Without really realizing what was happening, I made him my punching bag for all the pain I had in my life. I know that now. These bouts were always followed by regret, shame, and guilt. The balm I used to soothe those horrendous feelings was to use even more drugs. I couldn’t stand myself, but I didn’t know what to do or how to stop. I would promise Ras that I would never yell at him or hit him again and ended up doing it over and over again. My self-hatred grew deeper and deeper. How I loathed myself and all my actions not only with my dog, but with my family as well.

The dynamics with my family were the same as with Rasputin, except I didn’t hit them. My life and relationships were spiraling out of control. As my drug use increased day to day, my dream of a new life in Las Vegas became dimmer and dimmer. The insanity of my addiction was running rampant and I did my best to keep up despite the destruction it wrought.

Once again I sought the easy and quick solution. I decided if I bought a house it would fix everything—my girlfriend and I would get along better, Ras would have a back yard in which to play and grow, and everything and everyone would be okay. Needless to say the only thing that changed was my increased drug use. I had no idea what was wrong with me and why my best efforts only ended in more pain and misery. It was not until much later when I was clean and in recovery that I could look back and see I was an addict in full-blown, untreated addiction.

Right before I got clean I entered the darkest period of my life. Things became so intolerable at home that my girlfriend moved back to Chicago with the kids. As sick as I was, even I knew it was for the best. I was out of control and didn’t know how to stop. We sent the kids home first. It broke my heart because I loved them as my own. Their mother left a few weeks later. It’s been more than twenty-one years, but I remember the day I took her to the airport like it was yesterday.

After the plane took off, I headed to the first bar I could find. I stayed loaded and high for the next few years. It was always another day, another party. My disease progressed daily, and I was eventually fired from my casino job by the gaming commission. My downward spiral continued, and I had given up any hope of living a normal life. Losing my girlfriend and the kids had broken my heart. The pain became lumped together with a lifetime of unresolved feelings and emotions.

I gave up all hope and began a life as a full-time drug dealer and user. I spent less and less time with Ras. I was so firmly entrenched in my addiction that I relegated him to the back yard where he was mostly an afterthought. When I look back today, I think how little it would have taken to change things, but my disease had me in a stranglehold. I couldn’t use enough drugs to stop the feelings of daily shame and guilt. In fact, I became painfully aware that no matter how much I used I was still feeling. The drugs were no longer numbing my emotions; they had stopped working.

Without knowing I had given up, I began using as much as I could and anything I could get my hands on. I couldn’t even support myself by dealing drugs since I used most of them instead of selling them. Eventually I was left in a house with no running water, no gas or electricity, six months behind in my mortgage, my car repossessed, and not much will to live.

One night I came home and found a notice from animal control stating I was the target of an animal abuse complaint. I was to call them as soon as possible. My first thought was, “Oh my God, Rasputin.” Immediately I was flooded with shame and guilt. I ran to the back yard realizing I hadn’t even thought of him in I don’t know how long.

The picture I saw is still vivid in my mind today. Ras had lost a significant amount of weight due to my neglect. It was hard to look at him because I felt so ashamed. I promised him at that moment that things would be different, that I would take care of him, feed him, and walk him. “Everything is going to be okay,” I vowed.

I called animal control and made up a story about being on vacation. I told the agency a friend was supposed to take care of Rasputin, but got the dates mixed up. I had to make something up because I couldn’t imagine anyone being so sick and messed up as to let this happen, let alone me being that person. I was so deep in denial of what I had become that I couldn’t see the gravity of my situation. For the next couple of days I was diligent and took care of my dog. He looked better even after that short amount of time. But just as the endless promises I made to myself and others had failed in the past, so too did my vow to Rasputin.

What happened next is the true insanity of active addiction. Despite everything that had happened with Rasputin, I went on another meth, alcohol, and cocaine run. I didn’t think about Rasputin until I put the key in the front lock several days later.

As I opened the door, I had a feeling of impending doom—as if all the transgressions of my entire life were about to cave in on me in one well-deserved crushing blow. At that moment, all the pain of my life flooded in at once. I staggered to the back yard and looked wildly around for Rasputin. Around the corner of the house, I was confronted by the worst nightmare I could imagine. Rasputin had starved to death.

No words can describe this worst moment of my life. I had killed the last thing on earth that was still in my life. All I wanted to do was die. I felt that I deserved to die. I wanted the pain to end. It was like I was there, but not there. I was in complete and utter shock and didn’t know what to do next. I put Rasputin’s body in a huge trash bag. I threw up several times until I was gagging on bile. As the tears flowed I drove Rasputin away from the house and buried him in the desert. How could this be? What was happening? How could I tell anyone about this? Even today, more than twenty-one years later, it is still difficult for me to talk about.

The memories of Rasputin and his horrific death are daily reminders to me that I have a terrible, chronic, progressive, and fatal disease and if I don’t stay in recovery I am capable of almost anything.

Rasputin’s death and the events of that night saved my life. Truth be told, I wasn’t in much better shape than him. I weighed about 100 pounds and was actively committing suicide one slow day at a time, but I couldn’t see it. Rasputin was the one that woke me up.

The next night I abandoned my house and showed up at my parents’ door with a Radio Flyer wagon holding the last possessions that remained in my life. My parents accepted me with no questions. I let my house be repossessed. I had ideas of suicide, but I didn’t have a plan. I was alive, but not living, still in shock at what I had done. I honestly had no idea of how I was going to live with myself.

In a short amount of time I found a twelve-step meeting and at my second or third meeting a miracle happened. There were only five addicts at that meeting including myself. The first person that shared talked about the shame and guilt they had from abusing their dog in active addiction. I was totally stunned and couldn’t believe what I was hearing. How could this be happening? My biggest secret was being openly discussed in this small room by another addict. One by one each of the other addicts shared about how they had neglected their pets in varying degrees. I sat frozen in my chair, unable to move. With every fiber of my being I wanted to run away, but at the same time I was paralyzed.

When the last addict shared everyone looked at me. This is when the miracle occurred. Somehow, some way I shared about what I had done. I didn’t cry because at that time I didn’t cry in front of anyone. A power greater than me must have orchestrated this since it was beyond anything I could ever do.

A second miracle occurred as the meeting ended. After we circled up and said the closing prayer, each of them came up to me and thanked me for sharing. They all said they understood and to keep coming back. I thought to myself, “Didn’t these people hear what I said? Didn’t they hear what I did? Why are they telling me to keep coming back?”

I had found probably the one meeting, the one place on earth that would allow me to relate what I had done and not be judged for it. At that meeting I knew somewhere deep in my soul I had found a way to live with what I had done. That day began my love affair with my twelve-step fellowship and my journey of recovery.

As I worked the Twelve Steps and discovered I had a disease over which I was powerless, I became overjoyed. All my life I had been unable to figure out what was wrong with me. Almost everyone in my life had asked the same question. “What’s wrong with you?” As I became entrenched in recovery, I realized my problem wasn’t using drugs. My problem was the disease of addiction. Using drugs was just a manifestation of that disease. This awareness came from working the steps. The many changes that came later in my life were a direct result from applying the steps.

Years later, after a decade of healing and growth, I was ready to open my heart. I was married to the love of my life, Teri; I had the best sponsor in the world; and I sponsored many men.

Teri and I had just purchased our first house together and decided we wanted a dog. Part of my amends and reparation to Ras was that I would never have a pet again without being able to take care of it. Ten years later, I was ready. We started looking in the paper for a dog and found an ad for bull-dogos. Not knowing what a bull-dogo was, Teri called the number and the breeder informed us a bull-dogo was a mix of an Argentine dogo and an American bulldog. We got very excited and went to see the puppies.

We fell in love with a small white female and took her took home that night. Her name was BB, which stood for “beautiful baby.” We were impressed by the breeders and the way they took care of their dogs and we formed a close relationship with them. In no time, we brought BB’s mother, Dominique, home. This brought the number in our pack to four. Teri and I shared our love for BB and Dominique and the love and richness they brought to our lives. We now had two beautiful ninety-pound females who were part of our family.

Eventually we bred BB with the breeder’s stud, Diesel. We then had a pregnant female and experienced all the anxiety and anticipation of proud grandparents. It wasn’t long before BB delivered ten beautiful bull-dogo pups. What an amazing experience. Every day was an adventure. BB was a wonderful mother and many of our friends in recovery were at the house almost daily sharing in our experience.

We had decided early on to keep one of the puppies, and it was not an easy choice; however, BB made the final decision for us. She was very protective of her pups and spent most of her time in the whelping pen with them. It was hard for her because she also wanted to be with us. When she did spend time with us she always brought one puppy with her; a little monster with a head as big as his body. He had a brown spot over his left eye, just like the first Rasputin. When BB carried her little pup in her mouth he would squeal loudly and Teri and I laughed hysterically. We decided to keep the little male that BB had chosen.

For some reason it just seemed right to call him Rasputin. All the pups were gone by the time they were four months old, and our love affair with the new Rasputin only intensified. He was a dream dog. He was a lover and very protective. He was the baby we never had. Teri had been pregnant in our marriage, but she’d had a tubular pregnancy and the baby was never born. Looking back, I don’t think we ever really healed or grieved that loss.

So Rasputin became part of our family and helped us heal from the loss of our unborn child. He also eased the pain of what I had done in my addiction to the first Rasputin. Our new Ras became our baby boy. BB and Doma loved him, and Teri and I were as close to him as anyone could possibly be. He had an enormous head and weighed about 110 pounds. He was all alpha male, but very gentle and loving. We hug our dogs all the time and Ras was especially huggable.

Ras and I often would just stare at each other. I would hold his fat head and look in his eyes telling him how much I loved him and how grateful I was he was in our lives. I don’t have the words to describe the bond he had with Teri and me. He loved to come into my office to visit or lie on the bed next to me. I often thought of the original Rasputin when he did that. Sometimes I felt they were one and the same.

Teri and I moved into a new house two years ago. We really bought the house for the dogs. Whenever we looked at a house, our first question was always “how would the dogs like it?” We ended up buying a house with a huge back yard I later redesigned to be dog-friendly. The dogs loved the new house and so did we. It seemed at the time that our beautiful lives together would go on forever without change.

But change is inevitable. My sponsor of fifteen years became ill and entered the hospital. Despite surgery and a month-long hospitalization, he passed away the day after I celebrated twenty-one years clean. Our last conversation was me telling him I loved him and him telling me the same. “And enjoy your birthday celebration,” he had said.

When he died my world changed. He had been my sponsor, role model, mentor, surrogate father, and the most important relationship in my life. My real father had passed away seven years before and I was devastated. But losing my sponsor affected me much more deeply. When my dad died, I grieved, but I found peace through working the Twelve Steps. But what I experienced when my sponsor died was almost unbearable. It was the most difficult thing I had ever dealt with in recovery. Every day I was in a fog and would often cry. I cried myself to sleep every night and would cry every morning in my boss’s office.

It was nice to have a boss in recovery who could share my experience. There was no end to the love and support I received during that time, which is one of the many gifts of recovery. I had no regrets about my sponsor dying because I knew he had led a wonderful life and our relationship was special.
Just when I felt that I was getting to the point where I could function normally, I noticed Rasputin didn’t look well. After an appointment with our veterinarian, we were told he had an infection and we started him on antibiotics. He also was dehydrated and a dear friend of ours who is a physician assistant came to our house and gave Ras intravenous fluids.

Even though the vet said Ras only had an infection, I sensed something was terribly wrong. He didn’t seem to be getting any better. Eventually, Teri took him back to the vet where fluids were taken for tests and he was given an ultrasound examination. My feeling of impending doom returned. During the agonizing period of waiting for the results of Ras’s tests, I was crying all the time. “How can I live without Ras?” I wondered aloud. Teri told me to stop, that we didn’t know what was wrong, but the feelings of possibly losing him were almost too much to bear.

Finally, Teri called me to say Rasputin had terminal cancer. The vet said she did not know how long he would live. She said we would know when it was time to put him to sleep. The pain in my life went up another level. The next week was a nightmare of feeling lost, angry, scared, and confused. I was overwhelmed with a feeling of impending loss.

Rasputin went through all this with dignity and grace. He never complained. Whenever he got his intravenous fluids, he would calmly lie there like the good boy he was. As the cancer progressed, Teri and I got worse and worse emotionally. I was deeply depressed. Oh, how badly I wanted to hear my sponsor’s voice. Losing him and the coming loss of Rasputin seemed unbearable.

I knew from my years of recovery and working the Twelve Steps that I would be okay, but at the time I was as far from okay as I could be. Rasputin’s appetite decreased and soon he wouldn’t even eat his favorite food. He wanted to eat, but the cancer wouldn’t let him. Teri and I were slowly coming to the inevitable, but agonizing decision to put him to sleep. We talked to the vet about euthanizing him and set up a tentative appointment.

We spent the next few days taking him for short rides and short walks, which he still seemed to enjoy. When we asked him if he wanted to go for a walk, he would get up and run to the door. He could only walk for half a block, and I knew his spirit was willing, but his body was failing him. BB and Doma were also very depressed, which only made Teri and me feel worse. Again and again I thought, “How can I live without him? How and why could this be happening?”

I sought help from a therapist friend because I didn’t feel like I could live though this. As we spoke about what happened to the original Rasputin and the loss of my sponsor, the therapist counseled me about compound grief and how difficult it was to deal with. I cried constantly and as I did I could hear my disease voice telling me to be embarrassed and to shut down the feelings. Somehow I knew if I didn’t feel everything I needed to feel, I wouldn’t survive. If I attempted in any way to shut down those feelings, I would end up either relapsing or killing myself.

When my therapist asked me what Rasputin meant to me, the flood of tears became a deluge “He means everything to me,” I said. “Rasputin gave you a second chance,” the therapist said. “He came to heal you.” I knew he was right. I also knew putting Rasputin to sleep was the loving thing to do.

When I remembered what I did to the first Rasputin, I felt pain like it was happening at that moment. Even though I spent twenty-one years healing that pain through the Twelve Steps and recovery, I realized some healings take a lifetime.

At the therapist’s direction I took Rasputin’s fat head in my hands and looked in his eyes. “Thank you Rasputin,” I said. “Thank you for being part of my life and for all you gave me.” At that moment, I knew as I cried and looked into his eyes, that there were not two Rasputins, only one. A loving God had given me another chance.

When Rasputin’s breathing became labored, Teri and I knew it was time. Rasputin and his mother, BB, had moaned all night and everyone slept very little. As I write this, the voice of my disease is telling me to stop. “Why are you putting yourself through this pain again?” It’s telling me no one wants to read this; but then there’s my inner voice telling me it’s okay; there is a purpose. “It’s not for you to know the purpose, it’s part of your healing and it’s a story that needs to be told.”

Teri and I took BB, Doma, and Rasputin to the vet when it was time. After they put the catheter into Rasputin, we said our good-byes. How do you say good-bye to your best friend? It was so painful to watch Teri go through her pain, too. Rasputin was her baby boy, the love of her life. As much as I wanted to hold him, I let Teri lie on the floor with him. I held BB and Doma. Teri held Rasputin’s head in her lap and cried as the vet injected the medication to euthanize him. He and Teri stared at each other while his life slowly slipped away. I remember saying, “Almost baby boy, almost. No more pain.” And then, he was gone.

When we got home everything was dark, darker then I ever remember life being. It was like being in a movie theater with the lights down and the sound muffled. I don’t know how we got though the next week. Thanks to dozens of recovery friends and coworkers who loved us so much, we survived.
I still grieve the loss of my sponsor and Rasputin, but I am alive and glad to be. I know I will be okay. The darkness has lifted and the light of my recovery is shining once again. I was given a great gift by my sponsor and Rasputin, and I will not throw that gift away. A tremendous healing is taking place in me and in Teri, too. One of the gifts that came from this is that Teri and I are closer than ever. We have been loving and supporting each other while allowing each other to feel what we need to feel.

Every story should have a happy ending and there is one final chapter to tell. BB and Doma were so depressed that Teri and I started thinking about getting a puppy. Not to stop the grieving process or replace Rasputin, but because we still have so much love to give. In no time we drove to San Diego to pick up the newest addition to our family. His name is Balboa.

That my heart has once again opened is the gift of recovery. In my active addiction, I lived in so much pain. I was always afraid of being hurt and feeling the kind of pain I recently experienced. My solution then was twenty years of using substances and avoiding anything that could hurt me emotionally.

My healing continues in this life and I believe it will in the next. Just for today I will go home and love Balboa with all my heart and soul. I will smile and laugh as I watch him run uncontrollably through the house, harassing BB and Doma, and my heart will swell with gladness as Teri holds him and loves him.

For more info, please visit http://www.TailsofRecovery.com

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Excerpts from Chapter Two of Pain Recovery by Dr. Mel Pohl

According to a 2006 study, 90 percent of all people in the US receiving treatment for pain management receive prescriptions for opioid medication. These medications carry with them a risk of dependency and addiction. For those with chronic pain who become addicted when they take opioids for pain relief, the two conditions exacerbate each other, making both worse than they would be alone. Many professionals believe the benefits of opioid treatment far outweigh the risk of developing addiction, but those who do become addicted find themselves in a conundrum: They need opioids to treat pain, but when they take them, they experience horrible consequences.

With addiction, the problem exists not so much with the drug itself, but with the way that drug works in the brain and nervous system. Some of you are destined to develop addiction because of how “well” the drug works—both physically and emotionally. You were probably wired differently from birth, and with continued exposure to a drug, particularly an opioid (whether you started taking it for pain or not), you eventually became addicted.

Some people develop tolerance and physical dependence. These phenomena occur with continued exposure to certain substances over time. With increased use of certain drugs (e.g., an opioid), the body reacts by decreasing the effect of the drug, in this case pain relief. This is tolerance. Consequently, in order to achieve pain relief, you increase the dose of the drug. This adjustment works temporarily, but eventually the need for still-increased doses will occur. Eventually, the drug seems not to work any longer, which results in using stronger, more potent drugs in an escalating upward spiral.

If you become tolerant to the drug, this indicates that your body is “normalized” in the presence of the drug. In fact, you may become so used to the drug that you need the drug to feel normal. Without it, you feel terrible. This is physical dependence. When the drug is discontinued abruptly, you will feel withdrawal—in effect, the opposite feelings that the drug caused. So if opioids cause decreased pain and some amount of calmness and well-being, then withdrawal consists of increased pain and anxiety, body aches, stomach and muscle cramps, diarrhea, nausea, vomiting, insomnia, and agitation. This outcome is one of the main reasons some of you will feel the need to continue the opioid, since, when you try to stop or even reduce the dose, you feel terrible.

So what is the solution to this awful problem? You feel that you have to take the drug to feel any level of pain relief, even though it barely works. In fact, as you’ll learn, it actually may be making the pain worse due to a phenomenon known as opioid-induced hyperalgesia. You might consider cutting down the dose of the opioid; however, that presents the immediate problem of withdrawal. In the short run, cutting down or stopping will make you feel much worse. This is because the withdrawal of the opioid from your system inevitably causes a temporary increase in symptoms, including pain. This effect makes the process of coming off opioids challenging but not impossible. You may be tempted to substitute one opioid for another, which may temporarily put off the process.

We have treated hundreds of people with pain who are tolerant to and dependent on opioids. The withdrawal process is best done under medical supervision and temporarily, you are likely to feel worse. But on the other side, when the opioids have left your system for a week or two, your pain will diminish and you will start to feel better. The discomfort of withdrawal may continue for a while, even for several months in some, but eventually your nervous system will readjust to the absence of opioids and you will return to a state of well-being that has escaped many of you for years.

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Excerpt from Recovery A to Z...

An addict alone is in bad company. The essence of twelve-step programs is experienced when one person in recovery talks to or works with another, whether one-on-one or in a group. Many people in recovery find it easier to talk with someone who has personal experience with addressing the feelings and other manifestations of addiction rather than talking with a professional, such as a therapist, psychiatrist, or clerical person. But because people tended to isolate while in active addiction, it can be difficult for them, once in recovery, to seek the company and counsel of others in the program. This slogan reminds them that it’s important to do so. When someone in recovery is alone, old thoughts and feelings can surface, along with the conviction that getting loaded might be a good idea.

Anger is fear in a party dress. In the recovery community it is generally accepted that the basis of most anger is fear. Addressing the root fear usually gets to the root of the anger.

Life is painful. Misery is optional. While it is virtually impossible to avoid pain; be it caused by the loss of a loved one, a relationship, financial security, or a job; the extent to which a person dwells in that pain is entirely up to him or her. Some of life’s events are painful; it’s our emotional response that generates misery. Through regular step work, meeting attendance, and contact with a support group, a person can avoid being miserable, although no one has ever been able to avoid pain.

Projection - living in the wreckage of the future. Most people can become overwhelmed by thinking about the future, particularly in early recovery. One must live in the present day, based on what is happening during that day and leave the results to a higher power or the process of recovery, doing the daily footwork to stay clean or maintain abstinence regardless of what happens in the future, without reservations.

The elevator is broken. Use the steps. There is no easy way to recover. The process of recovery is simple, but it requires work. Those who suffer from addiction are usually looking for instant gratification or an ‘elevator,’ rather than doing the work necessary in the ‘steps,’ otherwise known as the Twelve Steps.

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Excerpt from Recovery A to Z...

Going to the first meeting of any twelve-step program can be a terrifying, confusing, and sometimes paralyzing experience. A person attending a meeting for the first time can take comfort in knowing that each and every person at the meeting had to go through the same experience of walking into that room for the first time. Every member or potential member faced the fear of identifying him- or herself as an addict, alcoholic, overeater, compulsive gambler, codependent, sex and love addict, and then taking that first key tag or chip. Regardless of the length of clean time, recovery, sobriety, or abstinence, there was a time when every single person at that meeting had only one day. That is, perhaps, the most important thing to remember.

There are ways to make the experience a little easier. “Meeting and Fellowship Etiquette” is intended as an easy guide to help you understand what to expect when you walk through the door of your first meeting and what to do while you’re there. We hope this guide will be useful for both newcomer and old-timer alike. Showing respect for each group, listening to the members of that group, and following the meeting format will help any newcomer (or old-timer) have an enjoyable meeting experience.

What is Meeting Etiquette?

Meeting etiquette consists of customs, manners, and propriety; it is the way to conduct oneself while in a recovery meeting. Meeting and fellowship etiquette has become an important topic among many members of the twelve-step community, as well as those who refer people to the various twelve-step programs. People “associated,” but not “affiliated” with twelve-step recovery, such as judges, law enforcement and medical professionals, and others are taking an increasing interest in what actually happens to a newcomer being sent to his or her first meeting. These professionals want to ensure that any newcomer is treated with respect and that those people they refer to meetings are not taken advantage of. They also want to ensure that the meetings actually provide those services as presented in the public relations material from various twelve-step service bodies.

Meeting etiquette has traditionally been a concept passed down from one recovering person to another, e.g., from sponsor to sponsee or a more experienced member to the newer member. There is no standard or accepted model beyond what is written in the Twelve Traditions; however, it is common for each member to take personal responsibility for his or her own fellowship and to make certain that there is an atmosphere of recovery found in the meetings. Most “violations” of meeting etiquette are usually addressed by more long-standing members of a group, usually in a kind and tolerant way.

Examples of meeting etiquette are as follows:
• Getting to a meeting early enables an attendee to get a beverage, use the restroom, socialize, etc., so they can:
  - Be sure of a seat before the meeting begins;
  - Avoid the disruption of performing these activities while members are reading or sharing. • Leaving and returning to one’s seat or speaking to one’s neighbors during the meeting is frowned upon, as this distracts those who may be sharing, or those attempting to pay attention. • If asked to read one of the passages or literature selections, it is considered respectful to read them as written, without adding comments or “sound effects.” The literature of each twelve-step program was written with great care to be of help to those who suffer. It was voted on by group conscience and each fellowship as a body agreed on the final presentation. Anyone with a disagreement on a particular reading should simply excuse him- or herself from reading it aloud and discuss it afterward, privately, with a sponsor or other program member. “Editorial comments” or “callbacks” in a meeting might confuse or alarm newcomers or others who desperately need to hear the message of recovery as it was intended. • Using only the language and literature consistent with the twelve-step meeting you are attending ensures that a clear message of recovery is being offered. Using mixed language from various fellowships sends mixed messages and can cause newer members to be confused about the meeting’s primary purpose. • The guideline against “cross-talking” or “sniper sharing” (see page XX) helps maintain a calm and safe atmosphere of recovery in the meetings. • “Stay in the meeting ‘from prayer to prayer.’” Since most meetings begin and end with a prayer, “staying in the meeting from prayer to prayer” means both physical attendance and mental focus on the meeting from beginning to end. • The Seventh Tradition states that groups should be fully self-supporting and decline outside contributions. This allows twelve-step groups to carry the message the way it was intended, without the influence of outside people or organizations. It is customary to put a contribution in the basket if one can afford to, but it is not required, nor it is appropriate for a visitor (or newcomer in the first thirty days of recovery, in some fellowships).
• Members do not publicly mention specific facilities, treatment centers, detoxification units, hospitals, halfway houses, etc. Doing so is considered an implied endorsement of these facilities/entities by the member. This is especially important if a member serves on an area or regional public information service body. As such, the member is viewed by the public as a representative of his or her fellowship and will think that the fellowship, rather than the member, is endorsing a specific entity. • Members refer to the meeting by its name rather than the facility where it is held. Referring to a facility may imply a relationship with the facility.
• Members refrain from mentioning specific drugs or tell overly detailed “war stories” (“drunkalogues” or “drugalogues”); it can make others in the meeting uncomfortable if specific drugs or excessive details are mentioned. • Many groups will ask members to keep their sharing between three to five minutes in order to give everyone who wishes to share a chance to do so. This is especially important if the meeting has a large number of members in attendance.
• Members show respect for the facility where the meeting is held. Twelve-step programs may not be affiliated with the facility, but they have a responsibility to make certain that the meeting area is left in as good a condition or better than it was found. Smokers should dispose of cigarette butts in an appropriate manner, using cigarette receptacles or ashtrays. Be mindful of behavior outside the meeting as well; negative complaints from neighbors to the facility is a direct reflection on the twelve-step group and have caused many groups to lose a meeting place. Many meetings are held in public places. Groups want to make sure that the behavior of a few members does not negatively affect the fellowship as a whole.
If someone is being disrespectful or placing the meeting location in jeopardy, then it is usually the responsibility of the chairperson or secretary to bring the issue to that person’s attention. However, no person has the power or authority to berate, reprimand, or expel another from a twelve-step program. They can ask an individual not to return to a particular group or facility if chronic negative behavior puts the facility or its members at risk. The meeting secretary has a responsibility to approach the disruptive person and explain, in a respectful manner, why or why not a certain practice is unacceptable.

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