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PostPosted: Tue Feb 16, 2010 3:06 pm 
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Oh, boy, where do I start? OK, I'll start at the beginning and try to make it as brief as I can. I just turned 46 yesterday. I have been on Suboxone for a little over a year, but have tapered down to 1mg. I started a year ago at 16mg per day, jumped down to 12mg from there after one month. Then started going down 1mg per month. My current Suboxone doctor told me in the beginning that he didn't have long-term patients and that he generally tapered everyone off eventually.

But let me back up a bit.....I started using drugs when I was about 15. By the time I was 17, I had a HUGE IV Heroine habit. I was doing, oh, 30 to 50 bags per day. Sometimes more, if I could get it. Long story short, this addiction lead to an extremely long prison term. I was locked up in November of 1983 and did not see the light of day (except for a few very brief paroles lasting only a few months) until July 6, 1998. I have been a free man ever since, but started abusing opiates again soon after my release, and by a little over a year ago, just prior to getting on the Suboxone, I was taking up to 10 or 12 40mg oxycontin tablets (crushing them) at one time - that's right, I wrote "at one time" and I'm not here to brag, I'm not here to compare, I'm here to tell war stories, I'm here because I am scared to death and desperately trying to figure out what I should do next. I have NEVER been able to maintain any long-term sobriety except for being on the suboxone. I've tried AA and NA, and can quote you chapter and verse of both big books, those programs never really worked for me. Suboxone works extremely well. I also see a substance abuse therapist once every couple of weeks (very helpful) and he runs a substance abuse group that is sort of like NA, but without the people looking down their nose at you for the suboxone, which is a plus and also very helpful. But now, here is my dilema:

It's all starting to unravel for me a bit now. I do NOT feel good AT ALL now that I am down to 1mg. Believe me, I KNOW what withdrawal is. I have relapsed, literally, hundreds of times. I know I am feeling the effects of withdrawing from Suboxone, but I guess the question I am asking now is this: SHOULD I BE DOING THIS?

There are several reasons why I am questioning whether or not I should be doing it:

1. I have been a severely chronic relapser for over a decade now, and even used drugs in prison.
2. During my treatment with my current sub doctor, a temporary replacement doctor at one of my monthly appointments told me he thought I was a "classic candidate" for "long term" suboxone treatment.
3. I *WILL NOT* go backwards. I don't care what it takes, but I cannot relapse again.
4. Today, for the first time in over a year, I actually considered using again. Talk about a totally WTF moment!

So, I guess, I would have to find another doctor if I wanted to get on some kind of long term suboxone treatment. And I am sure they are out there, but what I don't know is would one doctor let me come onto his case load and increase my dose back to, say, 6mg to 8mg per day, where I felt good? Where I felt like myself. Where I felt, dare I say (or write) "normal' ?

I cannot live like this, and I'm scared to death to get completely off this stuff right now....

I am open to suggestions from this community.

Thanks for reading.

Junkie781


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PostPosted: Tue Feb 16, 2010 4:16 pm 
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Hi junkie781 --

WOW! Such Honesty! Fantastic.

I read this with fresh eyes. I tried to put myself in your doctor's shoes. Does he know the history you just wrote out?

I would start there. If you are begging for help with an addiction/disease (yes, it is a disease - and the doctor had to get that in his 'suboxone' certification) - I have a hard time believing that the doctor would turn a blind eye to a sincere request for help. I know it happens, but I hope common sense would reign.

Thinking out loud - if I were in your shoes - I would tell the doctor exactly what you wrote (maybe a little less colorful :wink: and say - I am desperate NOT TO RELAPSE. I am ready to use again at 1mg - I'm fighting the good fight - but I am not able/ready yet to handle taper to zero. I want to stay productive as a citizen, in my community, and to myself and (perhaps) family.

See what the doctor says. If he say's I simply DO NOT DO LONG TERM - END OF STORY - then ask for a referral to someone who does. Tell him your ability to stay clean and out of jail is too important to you to just taper to zero and then relapse and face jail again. I mean if your doctor doesn't listen to you when you are crying out for help - then maybe it's a good time for another doctor anyway.

What's the worst that could happen? He might tell you no, and no referral (and then he should consider getting out of medicine - because of his oaths to help people and do no harm) - and you start calling around to other doctors / pain management / recovery clinics.

The best case is he decides your success is important to him as well as you - and that he want's to team up with you to succeed. Maybe another year, two, or forever. Ask him what his 'outcome' measurement is... It's good doctor lingo.

Everything is measured by 'outcomes.' If the outcome is to taper someone to zero and not care about relapse rates - then you know. If the outcome is to help you stay sober from heroin, and stay productive in society - then tapering you at this time is not a good idea.

K, I'll end my blather. I hope any/some of this helps. Regardless, please keep us posted! We are here for you.


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PostPosted: Tue Feb 16, 2010 4:16 pm 
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As I was reading your story the thought came to me "If anyone is a classic case for life-long Suboxone therapy, this is it." It was then interesting to read that you had spoken to a physician that said the same thing to you. I myself may end up on Suboxone for a long time and I have not ruled out for life and I'm here to tell you I don't think I have anywhere close to your history. At my max, 40mg of oxcodone is about all I would take at one time. 400mg at one time is something I can't even imagine.

If you are looking for advice, I'm happy to lump mine in with everyone else and I'd say that you should first talk with your current doctor and see if he will allow you to continue back at a more therapeutic dose for you. If not, see if he will help you transition to a different physician that will do that. And if that doesn't work, find such a doctor on your own. They are out there. You can find them.

Honestly, from the information you have provided, you have to be one of the most compelling cases for life-long Suboxone that I have come across. I can't imagine a physician that hears your story, followed by you telling them you can feel yourself going right back to the drugs, denying to keep you on Suboxone.


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PostPosted: Tue Feb 16, 2010 4:32 pm 
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Thank you very much for the replies. I have my group therapy session tonight, so that will also be a good place to bring this up. They have all advocated for me to stay on the subs long-term, and although I never discounted the idea, I guess deep down, part of me was hoping I could do this on my own, without some kind of "crutch" but I've got to say, right now, I am almost dysfunctional at work, and the urge to use is getting stronger by the minute....I am literally counting the minutes until I can take my next little tiny dose of suboxone without going nuts.

I think I will have to call my sub doctor tomorrow and see what he says, my next appointment is not until March 3rd, but I don't know if I can make it another two weeks feeling like this.


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PostPosted: Tue Feb 16, 2010 6:23 pm 
Hello junkie781 and welcome to the forum! I'm so glad you're here!
I agree with everything the others have said. But I'm going to give you my knee-jerk reaction in as strong as my words will come here.
I am not a doctor and I've been on Suboxone for less time than you have and do not have the same history as you. However, I feel safe in saying that you are treading on thin, thin ice right now!! You in no way deserve to be this close to a relapse!! Your next relapse could easily cost you your life!
I have made the mistake myself of not asking for more help when I should have....for thinking this was a self-will issue....thinking that if I could just suck it up and handle some physical w/d symptoms for a little while I could beat this thing on my own. I should have jumped up and down, screamed and yelled, and begged for help....admitted I couln't do this without more help. Even after being on Sub for several months, the over-confident, self-willed side of me, the addict in me told me I could reduce my dose rather quickly and get off this stuff and be fine. Well....it ain't so! After getting down under 4mg/day, the cravings have kicked in, the obsessive thoughts of wanting to use again, to escape (if only for a couple of hours) kicked in hard! I'm coming to admit and am now admitting to all my friends here....I'm in trouble! I am not near ready to wean off Sub....it's a recipe for disaster for me to keep my dose low enough to allow me to use and possibly get a little high on pain pills. So there it is.....I'm admitting it.....I am not ready to wean off, not today and maybe not ever.
Luckily, my doc is good with me staying on Sub for as long as I feel the need. You deserve the same kind of care. You have and are continuing to do your part in your recovery. You deserve nothing less than to get back up to a dose that keeps you stable and stay there until you feel ready to drop that dose.
Tell your doc everything you've told us....this is NOT a matter of weakness or self will. If he/she won't back you up on your decision....find a new doctor, period!!
Hope that wasn't too much of a rant....but I am feeling particularly strongly about this issue right now. You have helped me immensely by coming here and telling your story. I needed to hear someone else say that they were struggling with decreasing their dose and feeling extremely vulnerable to relapse. It all starts with a thought....a seemingly harmless thought. But you know what? If we are white-knuckling it to our next dose of Sub, teetering on the brink of risking our recovery....we've got a problem....a potentially very big problem!
I hope you agree with me that we've got to dig our heels in and understand and accept that we NEED our medication....everything we've worked so hard on could be lost by pushing ourselves too hard to get off Sub.
Please keep posting and thanks again! And congrats on all your progress! You are awesome to have made it this far back and you are awesome to be humble enough and willing enough to ask for more help.


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PostPosted: Tue Feb 16, 2010 7:58 pm 
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I'm very, very new here and still wet behind the ears, but let me just say that you're both awesome to be humble enough and willing enough to ask for help. It seems providence saw fit to have you interact tonight, and you both can make it. If I only know one thing, it's that silence can be deadly. And let me at least say that I'm thinking of you both, offering a prayer, and will continue to do so.

Hang in there; and junkie781, sad as it is to learn this about the medical establishment, sometimes we have to get really proactive and emphatic about what we need, fire the docs' sorry butts who won't help us, and steer the course of our recovery and wellbeing with our own hands. Seems counterintuitive, but sometimes it's just that way. Don't settle for less.


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 Post subject: Well, ok then....
PostPosted: Wed Feb 17, 2010 7:44 am 
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Thanks again for the responses. Let me just mention something that I may not have made very clear in my first post. This taper has been a very, very long and drawn out process. Like this:

12/08 = 16mg
01/09 = 12mg
02/09 = 11mg
03/09 = 10mg
04/09 = 9mg
05/09 = 8mg
06/09 = 7mg
07/09 = 6mg
08/09 = 6mg (we held at 6mg because I thought I might have to go on Chemo for my HepC
09/09 = 5mg (luckily, it was determined that I do not need Chemo at this time, so reduction continued)
10/09 = 4mg (this is where I started feeling not quite myself....)
11/09 = 3mg
12/09 = 2mg
01/10 = 1mg (really, really feeling strong depression, lethargy, cramps, mood swings, etc)
02/10 = .5mg (that was a couple of weeks ago and now I feel horrible)

Talking about this last night at my group substance abuse session and the consensus was I should call my Suboxone doctor today and tell him that I have been having thoughts of using again (I have!) and ask if we can go back up to the 6mg range for a while so I can work on myself a little longer.....not try to rush into things......I just WILL NOT relapse again, no matter what. If, for some reason, this doctor will not do what I ask, then I will find a different doctor who will. I am not going to die from this damned thing. I've come way too far for that. I took a .5mg sliver last night with some ambien and got about 2 hours of sleep. That's what most of my nights have been like since about 4mg to 6mg.....when I was up around 8mg, I didn't even use the ambien. I was ambitious at work, doing work around the house. Interested in my music (I'm a home recording musician), etc.....right now I just want to curl up in a ball and make everything go away.

Anyway, thanks again for the words of encouragement. I appreciate it very much. I will be calling my doctor in a couple of hours, we'll see what they have to say.


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 Post subject: junkie.............
PostPosted: Wed Feb 17, 2010 8:14 am 
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going backwards to 2mg per day is probably enough, set your sights on a low dose, I had absolutly NO w/ds till I got under 2mg, thats when everything started changing... I saw my shrink yesterday ( a very good Dr. by the way ) an he asked me if the shitty way I was feeling would go away with more sub, DA I'm also at 1mg per day.. BE STRONG, Mike


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PostPosted: Wed Feb 17, 2010 10:36 am 
Good morning junkie! Thanks for posting an update. I kinda figured you had been doing a very reasonable, slow taper over the months, but thanks for clarifying. I'm sure that's part of the reason you've done so well as you've tapered. It sounds like you have a pretty good doctor who doesn't have terribly unreasonable expectations. I'm hoping that, with that being the case, once you speak with him and tell him that you're not doing too good on this low a dose, he'll back you off the taper.
I think it's up to you and your doctor as to what dose you bump back up to. You seem to know pretty much exactly when you started to struggle.... I know when I did too. That tells 'me' that I need at least that amount of Sub to remain stable. But that's me.....I go see my doc this Friday so I'll consult with him about my issues. As for you....yeah, talk it all out with your doctor and come up with a Plan B - bump that dose back up to where you are no longer in such a risky place.
I totally emathize with where you're at! Good luck with it all.....let us know what the good doc has to offer!


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PostPosted: Wed Feb 17, 2010 1:49 pm 
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Called the suboxone doctor this morning, they made an appointment for me for today at 1:45pm. I am going to suggest a return to about 6mg, which, looking back, is about where I slowly heading off into the ditch.

I guess we'll just have to see what he says. I will post an update tonight.


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PostPosted: Wed Feb 17, 2010 2:22 pm 
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Good luck with your appt. I agree with poster who said to try and get stable at 2mg first... I bet you will be fine there since you've tapered so low. If 2mg doesn't work you can always go up. If your dr gives you the 6mg [and you are ok at 2-4] then you might want to consider stockpiling some for emergency...etc. Of course this may not be a good idea if you still have a parole or probation officer??

Congratulations on turning your life around. I can't begin to imagine the hell you went thru with all those yrs in prison. You didn't say what you were locked up for [and its none of our business] but I bet it was related to maintaining your drug habit which sucks. We could clear out over half the prison population with drug law reforms. The problem with that is over half of all the corrections, dea, law enforcement...etc would be out of jobs and the govt would not have all the control they now have... Politics...YUCK!!


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PostPosted: Wed Feb 17, 2010 3:53 pm 
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Hey - yeah, I went to prison for armed robbery (banks, many of them :oops: ) to support my heroin habit. I am fond of saying that I was not "arrested" I was actually "rescued." Because I surely would have killed myself on the drugs eventually. I'm not on parole or probation, I did my time (every f'n minute of it, believe me) and I am a totally free man, from a legal perspective.

OK, anyway, I'm back from my appointment. My sub doctor was extremely cool. He even said he was "very impressed" that I came in, since he's seen a LOT of people in the same position end up relapsing instead. Apparently, at such a low dose of suboxone, you can actually get somewhat high again if you consume enough of the right junk. NOT what I want to do.

So, we decided I am going to return to 4mg and hold for a couple of months then re-evaluate. I have already dosed to bring today's total up to 4mg and I feel 100% better :D

My sub doctor also told me that I may be a candidate for Naltrexone (marketed as "Revia") and that we could possibly transition me to that after a while, and then my primary care physician could handle the prescriptions if he agreed to it. He also suggested another possibility would be to have my primary care physician prescribe the suboxone as "pain management" for my chronic hepC symptoms. I did not ask about this, HE brought it up, because he's extremely cool and understands that some people may not want to continue to shell out $125 per month for office visits that no insurance will cover. I guess there are some gray areas in the laws that govern how suboxone is prescribed that give doctors some wiggle room..... I don't know, why else would he suggest it?

Anyway, I thanked him profusely for being so compassionate and understanding.

And now, here I am. Doing WAY better than I was this morning.

Thank you all for reading and especially to LatheDude, donh, setmefree, morningglory, sullimi and suboxfreedom for your responses. It's SO helpful to have understanding people out there who don't judge.

I think I will hang around this place.


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PostPosted: Wed Feb 17, 2010 4:05 pm 
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I'm likely a bit late with this reply since your appointment is about at the time I am writing this. I just wanted to jump in to say I agree with the several others who suggested that you may not need to go all the way back to 6mg. Certainly that sounds to be the spot that you started having problems, but that was several months ago now and your body has adjusted since that time. You very well may be able to stabilize and feel normal again at somewhere around 2 to 4 milligrams. I am a huge proponent of dose just being a number. Don't sweat the number. Use whatever is the smallest amount that provides the desired effect. I won't be surprised at all if your doctor tells you the same thing and starts you back at something less than the 6mg you are asking for. If that happens, don't let it bother you. Just give it an honest try. I really do think you'll be pleasantly surprised to find that you can get your life back again with less Suboxone than you think you need. And even if your doc does allow you back to 6mg, you may want to just give 2, 3 or 4 a shot for a few days and see how it goes.

Now, if for some reason your doc refuses any sort of a dose increase, well then you'll have some more work to do and we'll be here for you as you go through it. Just let us know what happens. The fact that you are taking all of these steps is a clear indication of how far you have already come! You should be very proud of yourself.


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PostPosted: Wed Feb 17, 2010 4:40 pm 
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Fantastic news!

My $.02 on the doctor saying 'chronic pain' for your HepC.

It might be a good idea if the referral works right. Here is my understanding. Buprenorphine is sold in 2 different tablets (and a generic). Suboxone (for opiate recovery) - and subutex - which is simply straight buprenorphine. Remember Suboxone has a 2nd ingredient to help avoid abuse in IV administration (Naloxone I believe).

People have been treated over the years for pain, typically Chronic Pain, with buprenorphine (subutex) - although it's not as frequent as methadone or other full agonist opiates.

Potentially, you could have your family physician focus on your HepC pain - if it is controlled with subutex (or generic) - and you get a 2 for 1 (craving relief and pain control).

If your doctor was serious, and would communicate this idea with your family doctor - it might turn out to be a great idea for you. Fiscally - you are a patient getting treated for pain control of HepC, using Buprenorphine (Subutex or generic) and there is no 200 patient limit.

Let us know what happens! AND WAY TO GO!


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PostPosted: Wed Feb 17, 2010 5:34 pm 
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Hi junkie781,
Let me add my congrats to the list of well wishers!!! You can tell you are determined to do this right... And good for you. It sounds like the Dr. you have is willing to work with you and it sounds like you are willing to do the work. That is a great combination... I for one think that the therapy is also an important part of recovery....Your hard work to remain clean is an inspiration to those of us who have an easier road to travel... We all have to fight the same disease But, to come from where you have is a great story....(No disrespect intended) Please keep posting so we can all share in each others recovery... Best of Luck & Take Care...


God Bless
TW


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PostPosted: Thu Feb 18, 2010 2:11 am 
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YAY, Junkie781! What a relief!


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PostPosted: Thu Feb 18, 2010 7:30 am 
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donh wrote:
I'm likely a bit late with this reply since your appointment is about at the time I am writing this. I just wanted to jump in to say I agree with the several others who suggested that you may not need to go all the way back to 6mg. Certainly that sounds to be the spot that you started having problems, but that was several months ago now and your body has adjusted since that time. You very well may be able to stabilize and feel normal again at somewhere around 2 to 4 milligrams. I am a huge proponent of dose just being a number. Don't sweat the number. Use whatever is the smallest amount that provides the desired effect. I won't be surprised at all if your doctor tells you the same thing and starts you back at something less than the 6mg you are asking for. If that happens, don't let it bother you. Just give it an honest try. I really do think you'll be pleasantly surprised to find that you can get your life back again with less Suboxone than you think you need. And even if your doc does allow you back to 6mg, you may want to just give 2, 3 or 4 a shot for a few days and see how it goes.

Now, if for some reason your doc refuses any sort of a dose increase, well then you'll have some more work to do and we'll be here for you as you go through it. Just let us know what happens. The fact that you are taking all of these steps is a clear indication of how far you have already come! You should be very proud of yourself.


Right, yeah, we decided that moving back to 4mg was good. And I feel 100% better. I may even reduce that to 3mg after a week or so.


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PostPosted: Thu Feb 18, 2010 7:47 am 
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TWINPLY wrote:
Hi junkie781,
Let me add my congrats to the list of well wishers!!! You can tell you are determined to do this right... And good for you. It sounds like the Dr. you have is willing to work with you and it sounds like you are willing to do the work. That is a great combination... I for one think that the therapy is also an important part of recovery....Your hard work to remain clean is an inspiration to those of us who have an easier road to travel... We all have to fight the same disease But, to come from where you have is a great story....(No disrespect intended) Please keep posting so we can all share in each others recovery... Best of Luck & Take Care...


God Bless
TW


Hey there, I appreciate your kind words of encouragement. I am very lucky to have a great support system in place and an extremely strong desire to do the right thing. I attend my individual therapy sessions every other week, and my group therapy sessions weekly. I have absolutely nothing against NA/AA but, despite my insane criminal background, I have done very well professionally and I am an executive with a large technology company and I work up to 70, sometimes 75 hours each week, which makes it nearly impossible to be involved in those meetings, mostly because I am usually asleep by about 7:30pm :lol:

However, with that said, to this day, I try very hard to apply many of the concepts I learned in those halls over the years (one day at a time, focus on the now, just don't pick up no matter what, giving it away to keep it, etc)

I'm going to stay here at 3 or 4mg for a couple of months to catch my breath and then the doc and I will decide what the best course of action will be. This is now the third physician who has been inclined to suggest that I may be a candidate for long term or even life-long chemical substance abuse therapy. Not sure how I feel about that. I mean, I definitely like the idea of living 8) it's just a bit daunting to think of being dependent upon some kind of pill to function in life, but then again, I take a half a dozen other prescriptions each day to maintain my health so what's one more pill at this point, right? :wink:


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PostPosted: Thu Feb 18, 2010 10:04 am 
That's right junkie....if it takes one more little piece of a pill to maintain your health for the rest of your life...so be it.
I'm so glad everything went well with your doctor, and glad you're already feeling better with upping your dose. I think I'm in a similar spot as you....need to just chill out at the ~4mg/day mark for a couple months or so, then reevaluate a further taper. Can't get in too big a hurry with this. After all, it took a number of years for our addiction to grow strong enough to kick our butt and get us into a lot of trouble!! Why wouldn't it take a number of years for our recovery to grow strong enough to keep us out of trouble?!!
Anyway....so glad you've got things straightened out and so glad to have you here on the forum...you've already added a lot!


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 Post subject: New Handle?? LOL...
PostPosted: Thu Feb 18, 2010 10:35 am 
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Hi junkie781,
It sounds like you have a great grip on your Recovery... That's awsome!!
Your Story is great and for me inspirational. Keep up the HARD work and be sure to keep us posted on your progress.... You may want to look into changing your name here to "Recovering Junkie781....." I hope to see more from you soon!
Take care and Best of luck in your continued Recovery!!!!

God Bless
TW


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