To Quit Opioids For Good… Use ‘The Art of War’ (Ep. 184)

Matt Finch: If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.

Announcer: Thanks for tuning into the Elevation Recovery Podcast, your hub for addiction recovery strategies. Hosted by Chris Scott and Matt Finch.

Matt Finch: Welcome to episode 184. This is Matt Finch. I hope you're doing well. I used to watch the awesome cartoon called GI Joe as a little kid. At the end of each episode, it said, "And remember kids, knowing is half the battle." Keyword, knowing. Well, in the case of recovering from addiction, I'd say that knowing the enemy, which is addiction, is probably one fourth the battle, knowing yourself is likely another one fourth the battle, and then taking courageous, educated, and persistent bold actions is probably the other 50% of the battle. You can also think of this process like an NFL football team. At the beginning of a new pre-season, how likely would you expect a football team to make it to the Super Bowl and then win if they didn't know the strengths and weaknesses of the teams they were to play all season? How likely do you think they would be if they also didn't know their own strengths and weaknesses? I know. Pretty lousy, right?

Matt Finch: Since the coaches of the teams know this, they watch the recorded games of all the other teams they're about to play. They study the games. They brainstorm with the other coaches and strategize. Then they teach their players the particular strategy for playing each different team. The coaches also figure out their own team's strengths and weaknesses. They can capitalize on and lead with their strengths whenever possible. By knowing a lot about the enemy, as well as a lot about themselves, a team will actually have a chance to win. Without knowing about the enemy or themselves, it will be much harder than it has to be, and possibly close to impossible. It was a Monday morning at work, and we were as busy as ever. Right as I finished screening the final person of the morning and preparing to hand them their intake paperwork, a woman walked into the waiting area of the methadone clinic where I worked as a counselor, and she looked like she was suffering very badly.

Matt Finch: "Oh man", I thought to myself, "I bet she wants to do an intake and I doubt the doctor will take anyone else today." "Hi there, my name's Matt, I'm a counselor here." I said in a warm and caring tone, trying to convey compassion and to let her know that she could count on me to help her out in any way I was able to. I was wildly popular as a counselor at the opioid treatment program because I was young, a former opioid-addicted person myself, I had tattoos, and I cared deeply about my patients and adjusted my counseling approaches for each individual. "I just finished inpatient detox and I feel horrible. Please, can I get on methadone today?" She was desperate, and I knew all too well that same feeling. Coming off opioids after long-term daily use leaves your brain in a deficient state that makes you susceptible to anxiety, depression, fear, and many other unpleasant feelings, including intense cravings to use opioids.

Matt Finch: I had felt this same way many times in my past life when I was addicted to opioids. "It's really late in the morning and we've been super busy with all the previous intakes, but I'll tell you what, I'll see the doctor and let them know the state you're in. And I promise to do all I can to get you seen today, okay?" I knew the only two factors determining whether or not the doctor would see her on such late notice would be what time the doctor was scheduled to go to work at another clinic, and also the mood that he was in. I walked out of the waiting room, which was full, it was standing room only at this point, and consisted of new patients filling out their intake paperwork, and current patients waiting in line to take their daily dose of methadone.

Matt Finch: I proceeded down the narrow hallway, which was brightly lit with several fluorescent lights until I reached the doctor's office, which is the last door on the left, and just 10 feet before reaching the nurse's dosing window, where there was a male patient in his 40's drinking his liquid dose of methadone. "Knock, knock." I set out loud as I simultaneously knocked gently on the door to the doctor's office, which has cracked open just a bit, but closed enough to where I couldn't see in. "Yeah, come in." The doctor said in a tone that sounded to me like he was in a good mood, which was a relief since sometimes he was in a very bad mood and the tone of his voice was much different on those days. My stomach would sink when I knew he was in a bad mood, but still needed to talk to him about something. "Hey, doc, a woman just came here who says she just finished inpatient detox and is feeling horrible. It looks like she's suffering from a massive case of post-acute withdrawal. If I screen her right now and she qualifies for methadone, could you squeeze her in?"

Matt Finch: Fortunately, the doc was in a great mood, and he didn't have to leave to go to work to another clinic for over three hours. And he was happy to squeeze her in. I screened her and she did qualify for long-term maintenance, LTD, which is our 180 day program where they would get stabilized on methadone then taper off by the final day, or before then they could do another intake and switched to methadone maintenance, where there was no time limit, and they could be on for many years or even decades or the entire rest of their lives if they choose. After the new patient finished filling out our intake paperwork in the waiting room, I took her upstairs to my office and told her to please take a seat. She commented on the nice view I had, which by my estimate, about half of all the patients I saw while working there did. My office had a huge window and you could see a bunch of trees, the Fashion Valley mall, rolling hills a few miles away in the background.

Matt Finch: My new patient said she had been smoking about a gram of black tar heroin a day on average for the past two years. And she was also addicted to prescription opioids for many years before that at the medical detox she went to and she was just released from, they gave her Subutex for three days, then took her off of it. And for the next few days treated her withdrawal symptoms with low dose quinidine, a blood pressure medicine, and Zofran, which is a nausea medicine. She said the entire time in detox she felt awful. And once she was released, the Subutex had completely worn off. And now she felt so horrible she said her only options were to either buy more heroin, or get on methadone. At traditional detox programs, the doctors prescribe various medications to treat opioid withdrawal symptoms. Depending on the place where you go, they may do a great job at helping the patient feel comfortable while detoxing from opioids, or they may not do such a great job regardless of whether a patient is treated in the way they need to feel okay while detoxing.

Matt Finch: Upon being released from detox, they almost always still feel significant physical and psychological symptoms of withdrawal. This is exactly what was happening with my new patient. She felt anxious, fearful, sore, tired, depressed, couldn't sleep, restless and had intense cravings to use heroin because she knew doing so would alleviate all of those symptoms within seconds. She told me her aftercare recommended outpatient treatment, and that they want her go to group counseling sessions and attend AA or NA meetings daily for 90 days and get a sponsor. However, when she left detox, all she could think about was using heroin, because the withdrawal symptoms were still so chronic. Unfortunately for her, and millions upon millions of others over the years and decades, traditional treatment programs do not teach or utilize holistic treatment plans for treating the second phase of opioid withdrawal, which is the post-acute withdrawal phase. For a long-term daily opioid user, this phase of withdrawal can easily last for three to six weeks, and often lasts for three to six months. And in more rare cases up to a year and even longer.

Matt Finch: The symptoms are usually not as severe as the acute withdrawal, but their persistence, lingering for so long makes them even more detrimental to achieving recovery for most individuals. And this was certainly true for myself as well. The truth is, most opioid-dependent individuals and even traditional treatment programs aren't aware of the many obstacles that lie ahead for the person beyond getting through the acute opioid withdrawal phase. If getting through acute withdrawal and then going to counseling and 12 step meetings was all that a person needed, relapse rates for opioid addiction wouldn't be 90 to 95%, or really by my estimate, closer to 99.9%. I call quitting opioids the war of your life, because there are several phases and each one presents its own difficult and unique challenges. And each one has different effective treatment protocols, which all need to be individualized and customized for the individual.

Matt Finch: In addition to the numerous phases of recovering from opioid dependence, there are also what I refer to as the seven obstacles of opioid addiction recovery, most of which are unknown to the vast majority of opioid-dependent persons, as well as traditional treatment centers. For most people that have been dependent on opioids long-term, the process of detoxing, recovering, and avoiding relapse is almost impossible, or at least it seems like it can be that way. Why? Much of the time it's simply due to ignorance, most opioid daily users that want to quit and attempt to do so may only know about the acute withdrawal, and many also know about the post-acute withdrawal as well, but that's the extent of their knowledge. If a person has a great plan to minimize symptoms during acute withdrawal, it's rare that they've also created or had a treatment center create a customized bio-psycho-social holistic treatment plan for the post-acute withdrawal phase, and especially beyond healing from pause.

Matt Finch: So yeah, the moral of the story is the Sun Tzu quote from the Art of War. If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself, but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle. Applying logic to the moral of this story, then it would make sense that if those things are true, that learning as much about addiction, and in your specific addiction, and learning as much as possible about yourself, self-knowledge, that elevates not only success rates for quitting, but also for staying quit and lifelong fulfillment and happiness. Again, knowing yourself, knowing the enemy. And so if you've been a long-time listener of this podcast, and you've heard a lot of the different resources we've provided for knowing the enemy, addiction, and knowing yourself.

Matt Finch: If you're new and you haven't listened to a lot of the old ones, some of the best ways to increase self-knowledge, at least some of the ones that have helped me the most, and hopefully they could help you too, are a few things. The Myers-Briggs Personality Test, you can take all these assessments for free online, the Myers-Briggs Personality Test, also Strengths Finder 2.0, that when you actually have to pay for, but it's very affordable. That one helps you come up with your top five talents, as well as the four tendencies. There's an online free questionnaire for that. It has to do with how you respond to internal and external expectations. And then just lots of journaling. Journaling, journaling, journaling, journaling over the years, spending quiet time, and much more. So I wanted to keep this episode short today, I've been creating a ton of content. I just wrote a huge epic article on Charlie Sheen's relapse prevention technique that he calls the Shame Shiver, and doing podcasts and podcasts. So thanks for listening, and I'll see you next time.