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PostPosted: Mon Aug 01, 2016 1:39 pm 
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Hello Dr. J,

Is there any definitive information available that gives a really good explanation of how incorporating exercise into your lifestyle will help alleviate the intensity of some of Suboxone's side effects.

My boyfriend is having a horrible time with anger, irritability and mood swings. I can tell it is very much related to the Suboxzone. He had a very, very difficult week last week where his emotions and the stress of his job and disappointments with his teenage boys sent him over the edge and he has been off Sub and using pills since Saturday.

I have worked to educate myself about Sub treatment and how to give yourself every leg up. I have seen exercise mentioned all over the place but was hoping there might be a blog, article or something that explains all the benefits and the importance of exercising and good nutrition. He is the type that will read it and mull it over. I am hoping it may be something that will make him think and decide to give the Sub another go.

Thanks in advance for your response.

Pops


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PostPosted: Mon Aug 01, 2016 10:15 pm 
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Hi Pops,

I have this discussion often, but when I read your comment that 'I can tell it is very much related to Suboxone' I have to wonder, how do you know? Any addiction, especially to opioids, has a profound effect on personality. The 'true self' is pushed aside, and replaced by a dishonest facade. The addicted person hates who he has become, and on some level wonders how anyone can love him. For that and other reasons he becomes angry when someone shows affection. Relationships are stormy, because as the sober person gets close, the addicted person pulls back... and then when the sober person eventually gives up the addicted person rushes back, afraid to be alone.

These things can heal, but it takes time. That's why people with addictions are ALWAYS recommended to avoid getting into significant relationships until at least a year of recovery. Of course if a relationship is already there, you don't have that choice... but understand that relationships with people in active addiction is literally being in love with someone who is trying to leave another lover-- but still on the fence about it.

The large majority of my buprenorphine/Suboxone patients don't have significant side effects. A few struggle with constipation, but that's about it. But 'living life on life's terms' is very difficult for a newly-sober person. For years the person has one main goal-- avoid being sick. But now the person has to deal with all the losses from the past, and all of the problems in the future.

Back to my original question-- why do you think whatever he is doing is related to buprenorphine? Buprenorphine does one thing-- it binds to opioid receptors, keeping the person from using heroin or other opioids. After a few days, any effects at the receptors are removed because of tolerance. At that point, you are seeing a person who is not under the effect of substances. The person no longer has any 'buzz' to look forward to, or any withdrawal to dread. He just has to tolerate life, and all of his feelings about himself, and what he has been doing for the past few years. Understand that I seem many people in my practice who are in their 30's, who NEVER experienced sober adulthood!! They've never learned how to tolerate emotions-- the emotions that come from getting or losing a job, breaking up with a partner, losing friends or parents to illness... or even the simple stress that comes with getting along with coworkers.

I think it is much more likely that THOSE are the things affecting him. Of course I don't know him-- but those issues are much more significant than the effects of buprenorphine, especially in a person who is already tolerant to opioids.

Your decision, if he is still using, is whether to stay along for the ride. As for your question, exercise and good nutrition are ALWAYS good for the soul. But just like with the rest of his life, HE has to decide to do those things. If he is still using opioid agonists, the chance that he will start exercising is very small, because using opioids and regular exercise just don't go together very well. I do have patients on buprenorphine who work out, run, or do other exercise-- but I think in his case the buprenorphine treatment will need to come FIRST-- and then hopefully he would start caring about the other things that make life better.

Good luck, Pops--- and don't let his issues pull you down. People use the term 'codependence' to refer how the partner of an addict becomes affected by the addiction, trying to change all sorts of things that she doesn't have any power over.


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PostPosted: Mon Aug 01, 2016 11:05 pm 
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When I made that statement that "I can tell this is due to the Suboxone" perhaps that is too general. I do understand that on his Sub he does not have that buffer against the stressors of life and emotions and thus that has created this ugly dynamic we have experienced for the past several months.

Yes, we have been together for 3 yrs and he has been an addict the entire time. I was not aware in the beginning and by the time I discovered the situation I was invested. Your words are dead on and makes absolute sense of what I see and I can match up and see correlations to what he says for instance it is like nails on a blackboard for him to hear me tell him how much I love and appreciate him he can't respond it's like he just wants to run and hide or stop me from talking. On the fence makes sense too because my biggest frustration is he tells me he loves me and his day to day actions tell me he loves me but then there is this vibe I get that he is not invested because he does zero work in the relationship. It feels like I stay constantly in a state of turmoil. He has pulled away sexually and pretty much in all ways that defines us as a couple so things have been extreme.

He has been on 8 mgs Sub for 5 months and as far as I know the Sub has worked well w/ no physical craving. From the beginning his prescribing dr has pushed some type of recovery group. He is very resistant. I can tell you he has baggage a lot of it and it's heavy stuff. I know you don't push the recovery group but I do think he would benefit from learning to express his emotions because he stuffs and just says "move on".

He had a week from Hell last week on the job and situations concerning his teenage sons. Both these situation cut him to the bone and inflicted the kind of hurt and disappointment that is unforgivable. He started using n Saturday night and has been taking pills Sunday and Monday. He has not taken any Sub. He has kept it a secret from me. I have not confronted him.

I understand the best chance for exercise will be only if he gets back on his Sub. I am hoping that happen. I'm scared. I don't want him to go back to the pills. I do my best to encourage him and the reason I wanted to find an article or blog about the benefits of exercise relayed to Sub therapy to share with him hoping he would give it a try.

I recognize I have been on the slippery slope of codependency. I am addressing my issues. I have another thread talking about those issues the title asks if addicts compartmentalize their lives. I do love this man. I want to see him healed and well. I'm a smart woman I know there are limits and love does not conquer all.

Thank you for sharing you're expertise and wisdom. I truly appreciate you're input.

Pops 8)


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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