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PostPosted: Thu Oct 14, 2010 12:41 pm 
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Hello Everyone,

New to the forum, not new to the problem :(

I was abusing opiates for probably close to 7 years, with the common progression from Vics & Percs to Oxy to eventually IV H.

The past 6 months I was on Subs, no other opiates at all, approximately 3mg/day, and was very heavily abusing Xanax (12-15mgs/day). I should say that I was getting the Subs from the street, as I had neither the insurance, the money, or the resources to find a Sub Doc. Anyway, I needed to stop and entered an inpatient detox facility on June 15. Many, many people told me that because of the long half life and long WD periods of Sub & Xanax, that IP was the wrong way to go, but for me I knew it was the only way I would stop; I simply could NOT stop using on my own.

After the IP detox of 9 days, I entered an IP facility for 22 more days. I'm not going to sugar-coat anything, it was a horrible, painful, excruciating experience. I was on high watch seizure alert due to the Xanax WDs, and coupled with the Sub WDs it was very, very intense. I probably slept maybe 10 hours in the whole 30+ days I was in, but by July 18 when I got out, I was actually feeling O.K. Sleep was coming a little easier, and I thought I might actually make it.

When I first came home, I was put on Tramadol for pain in my right knee from multiple surgeries, whether this was good or bad is debatable, but it happened nonetheless and I cannot change it now. I started to notice that I was taking more Tramadol than prescribed, and knowing how abuse quickly turns to dependence and addiction, I stopped the Tramadol, called my old Sub connect, and went back on a low dose of Subs approximately 3 weeks ago.

I have now been taking Sub for a little over 3 weeks, anywhere from 3-5mgs/daily. I have a beautiful girlfriend and a 2 1/2 yr old daughter with her. She has stuck by me through most of this process, and I badly want to be clean for her, my daughter, and most importantly myself. To me, clean is being off ALL meds. Not trying to start an argument or debate about maintenance, just IMO to be totally clean I must be off any and all meds.

I have a few questions and would really appreciate help, support, or advice. I have went a day here and there in the past 3 weeks without any Sub and have not really noticed any WDs. Since I have only been taking the Sub for a little over 3 weeks, and not more than 4mg/day usually, will I still experience severe WDs or will I be ok?

Also, I do notice that when I do not take the Subs, I have little to no energy. My GF is trying to get me back in school, as I am only about a year away from my Bachelors, and I want to start working, but the way I feel without the Subs not sure if this would be taking on too much too soon. Any Advice on this?

And thirdly, I notice also that besides having little to no energy, and being very depressed, (mainly because I'm 31, still live at home, have no job, no license, and no prospects of going anywhere in the near future) I have been sleeping 14+ hours/day. I think that literally, if I did not force myself out of bed I could sleep all day and night :(

I really want to get my life back together, and I know I have the tools to do it, I just cannot seem to beat this problem once and for all. Please any help, advice, support would be greatly appreciated.

As a disclaimer, anything expressed in this post is my opinion only, and my experiences, they are not blanket statements about other peoples experiences, or in any way describe how anyone else should feel or what they should do.

Thank you all for reading, and hopefully responding.

Best of luck to all those in the struggle, keep your head up!!

Will


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PostPosted: Thu Oct 14, 2010 2:14 pm 
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Dear Wills,

I'm glad you decided to post here. You will receive an amazing amount of help and support. I really hope that you will use this forum and the people who are here. It is a wonderful place.

I personally have no experience with stopping Sub. I haven't come to the point where I am ready to do so. There are many, many posts on this forum from people who do have experience with it. I encourage you to read through some of them. From what I understand, the amount of Sub that you are currently taking is too high of a dose to simply stop. It is critical that you wean yourself off of it, slowly. I know that cost is an issue for you but it will be well worth your while to invest the time and money into a slow taper.

If you go without it for one day you are not going to feel it, due to the long half life. Personally, I don't think it matters that you have only been on it for three weeks. At a dose of 3-5 mg per day, you are still going to feel it greatly if you simply stop. 3-5 mg a day is still a lot, even though there are those who take much more than that. There are many posts here about how you should do this, and you will receive a lot of helpful advice from those who know a lot more about it than I do. I have read here that people even experience some mild w/d after jumping off at 0.25 mg/day. You have suffered greatly, and my opinion, for whatever it's worth, is that you should plan and execute a slow taper. You will have a much better chance of success, and much less agony.

I hope that you will find a solution that works for you, and I wish you well in your efforts.

Sincerely,
~Rossma


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PostPosted: Thu Oct 14, 2010 2:37 pm 
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Hello WLS and welcome to the forum. I truly hope you are able to find the support and information you are seeking. I have to agree with Rossma - you would be in a much better position if you were to do a slow taper. It's also my opinion that you are suffering from PAWS (Post Acute Withdrawal Symdrome), especially since you say you feel better/have more energy when you take the sub. If you were to go back on a low dose, say 2-3 mg and taper down into the micrograms that will not only help you with the acute withdrawals but it should reduce your chances of developing bad PAWS later. I apologize if this is not what you were hoping to hear.

As for being clean while taking sub, I do disagree with you, but you're certainly not the first person to feel that way, and probably won't be the last. I do appreciate how you presented it though and the respect you gave to those of us who choose to stay on it.

Good luck and again, welcome. Let us know how you're doing.

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PostPosted: Thu Oct 14, 2010 2:41 pm 
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Rossma, thank you for the reply.

The thing is, I only have about 4mg left and I do not think I will be able to get anymore right now. My connect is all out until late Oct. and I don't want to call all over like a dope fiend to get Subs, plus I just don't know that many people anymore since I stopped using pretty much everything(cept the Subs obviously).

I would rather deal with a week of discomfort than go and do anymore opiates. I just hope that a week is all it is. I had all the Bupenorphine out of my system after being off totally for over 5 weeks, so now I don't see how my body could be THAT addicted after starting again for only 3 weeks. I'm not saying that what you are saying is not true, it very well could be. I am very educated about Subs and the half life, Bioav, ect. I guess ill just cut my last 4mg piece into 3 pieces, and try to take 1 piece/day for the next 3 days and see how it goes :(

Not looking forward to it, but I'm starting back school the 25th of Oct and I have various Job Interviews over the next few weeks and I just do not want to be on Subs anymore. I believe I can stay away from opiates without it as I have no desire to use at all right now.

Thanks again and I really appreciate the reply :)

Will


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PostPosted: Thu Oct 14, 2010 2:41 pm 
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Hi Rossma and the rest of my friends here. I haven't written too much lately because I have been feeling good. that is until a week ago. I find that all I do is cry. I am so depressed all the time. i fake it in front of friends and family but during the day i cry and cry. I sob, loudly and feel like it's the end of the world. my dose is still at 8 mg-a.m 12 mg p.m.. I find myself craving more, wanting to feel high. What gives? I was doing good. my next sub appointment is oct 19. it will also be my first day of counseling ever in my life. what is wrong with me. i am so disappointed. i thought i was doing good.

love, queenie


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PostPosted: Thu Oct 14, 2010 3:29 pm 
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Dear Wills,

I felt really bad when I heard that you only have 4 mg left. I guess all you can do at this point is try and see what happens. If you find that you are ill, I think it would be well worth your while to find a doctor to help you. You say that you want to get your life back on track. I personally would not be able to do that if I were experiencing any kind of w/d, acute or post acute. For me w/d the worst feeling in the world, and when I feel that way, I just can't do ANYTHING except lay in a ball and moan.

But, everyone is different to be sure, and perhaps you will find that you don't feel so bad. If it happens that you do however, I don't think that there would be any disgrace in calling around like a dope fiend to find a physician. Part of being in recovery is learning that we don't have to drive the bus all by ourselves anymore and that it is OK, and in fact critical, that we reach out for help and support when we need it. You are trying to become drug free, and it simply a means to an end. Spending a month in rehab is great, but it doesn't end there. And, you were suffering the whole time! Anyhow, I think that you should keep your mind open to the possibility that you might need some more help. Perhaps the medical staff at the rehab where you were could point you in the direction of a MD. Either way, I wish you nothing but success. Please let us know how you are doing.

Dear Queenie,

I am so sorry that you are feeling sad. I have battled depression all of my life and was hospitalized for 2 weeks in spring of 2009 because of severe depression. So, I know that horrible feeling. I call it circling the drain. For me, being on Sub does help but does not take away the depression. You know that on the dose of Sub that you are currently taking that if you take more you will not feel high or any different. The same with any opiates - if you take them while on Sub, you won't feel high. You won't feel any effect from them. I take an antidepressant medication and it helps quite a bit.

I find that this time of the year is difficult for me - coming into the winter, less sunlight, etc. I know that a lot of people feel that way. I hope that you will continue to reach out and to share your feelings, and even though it seems unlikely to you right now this feeling WILL pass, and you will come through to the other side. You have been through an awful lot. Be kind to yourself, eat well, get enough rest, and keep reaching out to others. I for one am here for you. Please feel free to PM me if you want to. I am thinking about you.

Sincerely,
~Rossma


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PostPosted: Thu Oct 14, 2010 4:14 pm 
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Junkie781 will now be playing the role of "Devil's Advocate" :D



WillsLifeStruggle wrote:
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Hello Everyone,

New to the forum, not new to the problem :(

I was abusing opiates for probably close to 7 years, with the common progression from Vics & Percs to Oxy to eventually IV H.

Having been an IV heroin user for more than twice that long, I completely understand.


WillsLifeStruggle wrote:
The past 6 months I was on Subs, no other opiates at all, approximately 3mg/day, and was very heavily abusing Xanax (12-15mgs/day). I should say that I was getting the Subs from the street, as I had neither the insurance, the money, or the resources to find a Sub Doc. Anyway, I needed to stop and entered an inpatient detox facility on June 15. Many, many people told me that because of the long half life and long WD periods of Sub & Xanax, that IP was the wrong way to go, but for me I knew it was the only way I would stop; I simply could NOT stop using on my own.

The pattern I see with addicts, and this includes me, is we have all the answers, don't we?


WillsLifeStruggle wrote:
After the IP detox of 9 days, I entered an IP facility for 22 more days. I'm not going to sugar-coat anything, it was a horrible, painful, excruciating experience. I was on high watch seizure alert due to the Xanax WDs, and coupled with the Sub WDs it was very, very intense. I probably slept maybe 10 hours in the whole 30+ days I was in, but by July 18 when I got out, I was actually feeling O.K. Sleep was coming a little easier, and I thought I might actually make it.

I strongly suggest you use Google and look up Post Acute Withdrawal Syndrome, since you have already experienced it and are about to experience it again.


WillsLifeStruggle wrote:
When I first came home, I was put on Tramadol for pain in my right knee from multiple surgeries, whether this was good or bad is debatable

Uh, I don't really think it's debatable. And I guess I'm wondering how you had insurance for multiple surgeries and to be put on Tramadol, but you don't seem to have insurance for suboxone? Sorry, but I can't help but notice something seems a bit fishy.


WillsLifeStruggle wrote:
I have now been taking Sub for a little over 3 weeks, anywhere from 3-5mgs/daily. I have a beautiful girlfriend and a 2 1/2 yr old daughter with her. She has stuck by me through most of this process, and I badly want to be clean for her, my daughter, and most importantly myself. To me, clean is being off ALL meds. Not trying to start an argument or debate about maintenance, just IMO to be totally clean I must be off any and all meds.

OK, I know you're not trying to start a debate, and I will not engage you in one, and like hatmaker, I appreciate your approach, but you are creating a false choice here. Considering the length of time and type of drug abuse you engaged in, your expectations of being able to stay clean for any length of time without either becoming a fixture in 12 step recovery programs or on some kind of maintenance is, frankly, ludicrous. How clean will you be when you're cooking smack again in 6 months because you refuse to entertain the idea of suboxone maintenance under the supervision of a physician? Sorry, I just don't understand the logic here. Again, I am just being the devil's advocate. I have both compassion and sympathy for you as a fellow addict and human being, but with that compassion comes a sense of responsibility to call BS when I see it, and that's what I think I see in the false choice of "To me, I must be off all opiates to be clean" mentality. It's a false choice. You're an addict, and you're never not going to be an addict. You have a choice of maintenance or becoming a piece of furniture in the 12 step rooms, or jails/institutions/death. That's the real deal for just about every addict that ever did or will exist.

WillsLifeStruggle wrote:
I have a few questions and would really appreciate help, support, or advice. I have went a day here and there in the past 3 weeks without any Sub and have not really noticed any WDs. Since I have only been taking the Sub for a little over 3 weeks, and not more than 4mg/day usually, will I still experience severe WDs or will I be ok?

Strap yourself in. It's going to be very uncomfortable for you. Sorry.


WillsLifeStruggle wrote:
Also, I do notice that when I do not take the Subs, I have little to no energy. My GF is trying to get me back in school, as I am only about a year away from my Bachelors, and I want to start working, but the way I feel without the Subs not sure if this would be taking on too much too soon. Any Advice on this?

Sorry, but my advice is to find a doctor who can prescribe you suboxone, or plug in to AA or NA and do 90 meetings in 90 days, get a sponsor, work the steps, get involved in the program. Heavily involved.


WillsLifeStruggle wrote:
And thirdly, I notice also that besides having little to no energy, and being very depressed, (mainly because I'm 31, still live at home, have no job, no license, and no prospects of going anywhere in the near future) I have been sleeping 14+ hours/day. I think that literally, if I did not force myself out of bed I could sleep all day and night :(

You can tell yourself that you're depressed because of those personal issues, but the most likely scenario is you are feeling this way because of the chemicals you are putting in your body and because that dose is inadequate to occupy enough of the receptor sites in your brain to produce a desirable affect. And your solution to this problem is to stop the suboxone completely, which, from where I sit, makes absolutely NO sense at all. I know you don't want to hear this, and I am sorry that you don't want to hear it, but I'm here to be respectfully honest with people, not give them lip service, and based on the history you posted, you really should consider suboxone. Do you think your 2 year old daughter cares if suboxone is a opiate? I assure you she does not. She would just like her daddy to be happy, healthy and engaged in her life is my guess, and the path you are heading down is not going to produce that any time soon.


WillsLifeStruggle wrote:
I really want to get my life back together, and I know I have the tools to do it, I just cannot seem to beat this problem once and for all. Please any help, advice, support would be greatly appreciated.

I hate to tell you this, but nobody "beats this problem once and for all" You're an addict. You're always going to be an addict. You can't "un-ring" that bell, my friend. All you can try to do is play the hand you've been dealt.


WillsLifeStruggle wrote:
As a disclaimer, anything expressed in this post is my opinion only, and my experiences, they are not blanket statements about other peoples experiences, or in any way describe how anyone else should feel or what they should do.

You seem like a nice guy, but you're on the wrong track in my opinion. Please reconsider your stance on suboxone maintenance. It does NOT have to be permanent, but with that kind of history, and the duration of active abuse that you describe, I just don't see how a few months of low dose suboxone from the street is the answer. Simply put: it's not. And you're in for a rough ride.

======================================
Devil's Advocate mode: OFF


Listen, man, please think about what you're doing. Once you become a drug addict, there's no turning back. I do hear ya on wanting to be "totally off drugs" I really do. I've been abusing drugs for over 30 years. And I've got HepC to show for it. Doing it MY way got me nothing. The only way I was able to "stop the bleeding" was to get on suboxone and get in therapy. And I've come a long way, but I've still got a long way to go.

I hope my post gives you food for thought. I did not try to antagonize you, I merely wish you to stop and consider your options. I sincerely wish you all the best.


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PostPosted: Thu Oct 14, 2010 5:10 pm 
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Thanks for the reply Junkie781,

I wont lie, my initial knee-jerk reaction to your post was some anger, but after re-reading I DO appreciate you honest, pull-no-punches approach. I had my surgeries years ago, when I had a steady job and health insurance. I have 3 screws in my knee and I get severe pain from time to time because of osteo-chondritis.

The Tramadol is non-narcotic, and I went to a self-pay walk-in that my GF paid for me, and the Tramadol is very inexpensive as an RX. I won't say it was definitely a bad thing, however the physical pain in my knee is not nearly as bad as all the emotional, mental, physical anguish from addiction. I just decided the Tramadol was not right for me as it posed too many potential pitfalls.

Also I do appreciate your "devil's advocate," however I do have the same information you do. I know once an addict always an addict, once you turn into a pickle you never go back to a cucumber, ect. From all of the programs I've been in I probably know every AA/NA slogan there is lol.

I am not saying that I will not be a drug addict anymore, what I am saying is that I will not be an "active" addict anymore. I don't think Suboxone is active addiction, don't mistake me, but I just want to be off of everything, Suboxone helps me but still just doesn't make me feel right.

Honestly, if I had a means and a way to get a Sub Doc, I probably would stay on it for longer. I just don't at this time have a way to do it, and going back to full-agonist opiates is not an option for me as I do have a daughter to consider.

So the only option for me really IS to get off of everything. I can't get Subs, can't do opiates, and refuse to get on Methadone. If I had other options I would probably consider them, I just don't at this time. My GF said I may be able to get on her insurance from her job under our states' laws, but I seriously doubt it as we are not married.

I know I wont be using dope anymore, I haven't in almost a year now and to tell you the truth the needle and all the complications from it (tracks, diseases) just doesn't appeal to me anymore. I would say my biggest danger is getting back into pills, I guess only time will tell.

I just do not understand why my only choices are Sub/Methadone maintenance, NA, or jails/institutions/death. My father was on heroin while doing 2 tours in Vietnam, and he came home and never used it again. I will pray, and I have my daughter and my GF and my family. These will be my support system and motivations and I hope to succeed.

I have no delusions that this will be easy. I know the about WDs, PAWS, and everything that comes along with it; I just feel that I simply MUST do this.

Thank You for the reply, I do GREATLY appreciate it, I know that your reasons are pure and your intentions are to help. I believe in what you said, and I hope that I will be able to do the next right thing and live a drug-free life.

Best wishes to all those in the struggle, keep your head up!!

Will


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PostPosted: Thu Oct 14, 2010 5:15 pm 
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Just FYI - Reckitt-Benkiser, the manufacturer of suboxone, has a patient assistance program. If eligible, your medication would be 100% covered for one year. It's specifically for uninsured people. You could start calling around and see what doctors in your area have room for another patient on that program. There is info about it posted under the "Links" section on the main index page of this forum.

Good luck.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Thu Oct 14, 2010 5:29 pm 
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Hatmaker, does this also cover the Dr. visits as well as the medication?

Thank you for the information!!


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PostPosted: Thu Oct 14, 2010 6:49 pm 
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No, unfortunately it doesn't cover doctor visits, but the docs are encouraged to give patients on the assistance program reduced fees. I honestly don't know if they do or not, but it is encouraged. Good luck to you! I really hope it works out. Please keep us posted.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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WillsLifeStruggle wrote:
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Thanks for the reply Junkie781,

I wont lie, my initial knee-jerk reaction to your post was some anger, but after re-reading I DO appreciate you honest, pull-no-punches approach. I had my surgeries years ago, when I had a steady job and health insurance. I have 3 screws in my knee and I get severe pain from time to time because of osteo-chondritis.


OK, good, I'm glad you didn't misunderstand my intent, which is only helping another addict. This is a life and death struggle and I take it very seriously, as I'm sure you do.

WillsLifeStruggle wrote:

The Tramadol is non-narcotic, and I went to a self-pay walk-in that my GF paid for me, and the Tramadol is very inexpensive as an RX. I won't say it was definitely a bad thing, however the physical pain in my knee is not nearly as bad as all the emotional, mental, physical anguish from addiction. I just decided the Tramadol was not right for me as it posed too many potential pitfalls.


A wise decision, since I've seen many horror stories about it. And, you did end up back on suboxone over it, right?

WillsLifeStruggle wrote:
Also I do appreciate your "devil's advocate," however I do have the same information you do. I know once an addict always an addict, once you turn into a pickle you never go back to a cucumber, ect. From all of the programs I've been in I probably know every AA/NA slogan there is lol.


OK, that's good, but knowing the slogans does not a 12 step recovery program make? You're not going to take suboxone legally, through a doctor, that's your decision, but my guess is, anyone who was taking suboxone is likely a full-fledged drug addict, and I have NEVER, EVER, in my almost 50 years on this earth, met a single drug addict who can stay clean for any length of time without being VERY, VERY involved in a 12 step program, working the steps, going to meetings multiple times per week (3 or more) and I really saw no indication at all from your posts that you're doing THAT, and you've told us you can't afford suboxone, so what, exactly, is your recovery plan? I sure hope "probably knowing every AA slogan there is, lol" is not your plan, because I'm here to tell you that won't work, I've been there and done that. 12 step programs CAN work for opiate addicts, but you have to literally embrace it and make it a daily part of your life, are you doing that?


WillsLifeStruggle wrote:
I am not saying that I will not be a drug addict anymore, what I am saying is that I will not be an "active" addict anymore. I don't think Suboxone is active addiction, don't mistake me, but I just want to be off of everything, Suboxone helps me but still just doesn't make me feel right.

Honestly, if I had a means and a way to get a Sub Doc, I probably would stay on it for longer. I just don't at this time have a way to do it, and going back to full-agonist opiates is not an option for me as I do have a daughter to consider.


This is where you're kind of losing me. You have a daughter to consider so you won't find a way to get suboxone legally, but you were OK with buying it off the street illegally? Hey, don't get me wrong, I've been to prison because of my addiction.....I'm definitely not looking down my nose at you or anything like that, but I think I see some fuzzy logic and rationalization going on here.......think about it, you were breaking the law, risking going to jail to get suboxone illegally, but you're not willing to find a way to get it legally, through a doctor, and one of the criteria you're citing for getting clean is "hey, I have a daughter to consider, you know." What's your daughter going to think if you have to go to jail for possession of suboxone that isn't yours?

I do understand your struggle, though. Don't misunderstand me... (I think you know I'm just tying to help)

I've heard that the drug company that makes suboxone has a program that pays for one year of prescriptions, maybe you could look into that?


WillsLifeStruggle wrote:
So the only option for me really IS to get off of everything. I can't get Subs, can't do opiates, and refuse to get on Methadone. If I had other options I would probably consider them, I just don't at this time. My GF said I may be able to get on her insurance from her job under our states' laws, but I seriously doubt it as we are not married.

I know I wont be using dope anymore, I haven't in almost a year now and to tell you the truth the needle and all the complications from it (tracks, diseases) just doesn't appeal to me anymore. I would say my biggest danger is getting back into pills, I guess only time will tell.


Can I ask you a question? How old are you? I'm just curious. Because if I had a dollar for every time I said "I know I won't be using dope any more" I could retire today! My guess is you're relatively young, but who knows? I've definitely been wrong about a great many things in my life! :lol:


WillsLifeStruggle wrote:
I just do not understand why my only choices are Sub/Methadone maintenance, NA, or jails/institutions/death. My father was on heroin while doing 2 tours in Vietnam, and he came home and never used it again. I will pray, and I have my daughter and my GF and my family. These will be my support system and motivations and I hope to succeed.


You don't have to understand it, because that's not what I'm saying. What I'm saying is, your claim that you'll "never do dope again" is reckless at best. How could you possibly know that? And being an addict, I'm sorry to tell you this, but the fact is, the likelihood that you'll "do dope" again is roughly equivalent to the likelihood that you'll continue to be a boy. I just think that's a frame of mind that leads to relapse, and the reason I think that is because it's lead to ME relapsing many, many times. It's just me giving you my experience.

WillsLifeStruggle wrote:
I have no delusions that this will be easy. I know the about WDs, PAWS, and everything that comes along with it; I just feel that I simply MUST do this.

That's fine, but "feeling that you simply must do this" is not a recovery plan. It's wish-thinking. Again, I don't want this to come out wrong. I'm not trying to beat you up here, but everything you're typing here could have been me 20 years ago. You don't want to know how many times I've relapsed in the last 20 years because I felt like I "simply had to do this" when it came to staying clean, but wasn't absolutely immersed in AA and/or NA. Oh, sure, I stayed clean here and there for 6 months or 9 months or 3 months, and once even for about 18 months, but I always eventually relapsed and all of the language I used and ideas I had over those years sounded just about exactly like the stuff you've been posting here.

I'd be a jerk for not at least mentioning it, right?
:)

WillsLifeStruggle wrote:
Thank You for the reply, I do GREATLY appreciate it, I know that your reasons are pure and your intentions are to help. I believe in what you said, and I hope that I will be able to do the next right thing and live a drug-free life.

Best wishes to all those in the struggle, keep your head up!!

Will


Thanks for not taking my strong opinions the wrong way, Will. I really hope you can hold it together, man. I won't brow beat you any more, I promise! :lol:


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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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