~ Strategies for the End of the Journey ~ [EV-I]

end_of_line_by_marc_mebarak-d3857p9

When God closes a door, he opens a window.

True enough, if there are gays who can marry in your city; outside may be a plague of spiders or a tsunami  – but this piece isn’t about the immutable external reality of the first mover, but rather the seemingly alterable internal world that makes up the “us-ness” architecture: more specifically relating to cognitive applications in abstinence.

This will call on the literature, but also informed by opinion, it may or may not hit the threshold for the RB (research blog) search engine; we’ll let the review board decide.

However, in quitting anything, from illegal narcotics;  to sex; to cigarettes; to alcohol: there will be many strategies that are core – that simply apply to everyone. And almost as many which are purely personal, of course.

The personal must be discovered.

However, why not arm yourself with the core?

The core contains removing behavioural cues; medications to reduce withdrawal or craving; treating underlying conditions; and improving cognitive architecture so that craving can be resisted and executive power restored. This will include “mindfulness” style techniques in this piece. But also some of the more traditional strategies, only stripped back.

Forgiveness” and “acceptance” are another set of terms that are, perhaps, more “soft”; but very important concepts. This piece will focus on alcohol, but will apply more broadly.

To begin; there is no stigma in therapy or medication anymore. We could all benefit in having a paid sounding board to assist us, indeed, there was a time when every person had their analyst. If you are living in a country where access to healthcare is available to you; it is all but criminal not to accept this assistance. Many places are not so lucky.

~The First Step Therapies~

In the case of alcohol, I would argue there is a causal relationship between violence (that is stronger than Meth in some studies), depression and anxiety. Even presuming there is no initial hidden condition being “self medicated” – there is almost certainly a chemical component that needs to be addressed in treatment on substance abuse cessation. As far as medication  goes; a general assistant such as escitalompram and a long acting benzodiazapine, at first, like diazepam, is a good genuine first step.

Moderate to high dose Mirtazapine (30-45+) has a unique and well rounded mechanism set, and Sertraline I am a fan of as well. Though escitalopram does have the best combined profile for actually working and being quickly tolerable.

Regarding “tolerable”; they all have an “upset stomach/flu” period at the beginning, and end, of treatments; though Mirtazapine does have weight gain of ~5kg and extreme lethargy in some cases (*both H1 mediated, I imagine, both at the lower doses too, and likely impacted by time of day taken as well as depression sub type: but I can’t prove any of that). Also, the afore mentioned medications are all nowhere near as addictive as something like Venlafaxine.

Venlafaxine will work; it has the beauty of leaving open the option to keep increasing the does until a new mechanism additionally kicks in. It is reasonably unique in this. Vfax, however, is the most like trading one addiction for another. It works the best and the fastest on paper, but is another thing you will perhaps have to concentrate on in order to get off of at a later date. The ones listed above have mitigation options. The company says 95% have no trouble changing dose with Vfax – I doubt any less than 50% of people find significant trouble. But it may be worth the trade.

A final thing on this topic, since medications have been addressed elsewhere [link crux]; drug expectations must be realistic. The above medications are “background drugs” – you are not supposed to “feel them working”. I consider them more like “shields”, a piece of equipment you are fortunate to have access to that can assist you in dealing with withdrawal, and the period of readjustment. Or as a more adaptive addiction at worst.

I think with drinkers in particular this is never quite explained. It is not like pouring a drink, it is like taking a vitamin (*which reminds me, also take thiamine when you stop alcohol, it would take too long to explain : but have a little faith; this is the internet, after all, what could possibly go wrong?).

The point is medications are an important part of any treatment regime. If you are in a country where you can access them, it is silly not to. Think about it; you already use potent daily drugs to get by, right? Just do not think they are “not working” if after the initial one-ish weeks of headaches and tummy aches you “don’t feel any different”. That is very likely not the case.

Also, with some you will not have reached the effective dose yet. Again, the medications listed above can usually be started on what is considered the “effective” dose level, or it can be quickly reached. Your doctor will (hopefully) tell you all this, in the 15 minutes it takes to diagnose you with the computer check boxes and write you a script/hand you a sample. And do not be scared by hand outs: they must list every possible thing to protect against legal liability. The sample group these have been tested on now is LARGE.

(*If you would like an opinion on a compound not listed, contact me.)

But in general, remember two things: 1) There may be an underlying reason why the addiction took hold in the first place that you are unaware of; and 2) There is a chemical component that needs to be addressed now regardless.

Would you attempt to stop smoking without nicotine gum and/or patches? Of course not, who would. And if you did try, the odds are you probably would not do so and be successful (the average is the forth attempt, with assistance). And quitting smoking won’t kill you. The same can not be said for alcohol.

Similar to nicotine, alcohol base craving must be reduced in this manner, and the imbalance created by dependence moderately mediated.

Drugs like Bupropion are effective, though essentially only prescribed for cigarette cessation in Australia, rarely (if ever) as monotherapy for the depressive illnesses. There are also a range of negative reinforcing compounds for alcohol that could fill their own piece. To suffice it to say, avoid them.

Cigarettes have an inhaler, a delivery system to mimic the action of the initial addiction. Alcohol requires a replacement habit as well. And this is where one benefits from being personally focused and creative in planning out a personal arsenal of responses for both boredom and craving.

One mindfulness technique, that I have named here “snap-back”, is key to not buying that drink. Whenever you find your mind dwells in that direction; observe, rationally dispute (ie forcefully say to your systems ‘NO’, as neural retraining) and then “snap” your attention back to silence. Or to your music, to your TV program. It does not matter what you snap back too; but this is a universal application technique. And you will use it a lot.

Do not blame yourself if this happens often, especially at first. Even every other second. It is the “go to” circuit that is being retrained here; it would be stranger if this was not a frequent occurrence.

You don’t actually “want a drink” per se; rather you have set up a “when this, activate that” system. That is what you are feeling, it is mislabelled. You can highjack other systems, like by drinking a glass of water or orange juice, because all of these circuits interact. You would switch off parts of the craving, through back doors (drinking muscles active, stomach distension…others). Soon you would “crave” orange juice. It is a behavioural conditioning exercise. We killed a lot of horses to work this stuff out; have some respect for the dead already.

Forgive yourself for indiscretions. There is little benefit in the alternative. Indeed, “disappointment” and “guilt” are likely along some of the very same artificially up-regulated depressive affect circuits we are trying to by-pass, apoptose and rewrite. There is a literal retraining going on of neural pathways. This is why “snap-back” works best when it is militant in its application.

Your brain must know you are serious before it will seek out alternate routes for that connection, without requiring the substance. Once this is done, craving will decrease to removal.

Replacement substitution can help. There is always a reason for relapse, every single day. The presentations of such circumstances will be more salient. Spiritually, if you believe in such things, this occurs because the universe likes to test you; you asked it too. This, anecdotally, will often be 3 times, with increasing difficulty – the 4th and final the “most reasonable” and most difficult.

Resist.

Neurologically, your brain is seeking the drug input and so makes salient the cues that preceded intake in the past; especially whenever doubt or resistance was encountered. You will see every minute problem, you will see them stack up, and they will appear worse than ever. It will be darkest in the death throws; just before the alternate pathway is reset.

Resist.

It is always darkest before dawn.

And like when training a child (I don’t have kids): to reinforce the drug pathway at all means that, essentially, you’ve told the system it need only reach a more desperate point than the one previous, and drug intake will be achieved. The command is that this is the new system you want put in place. This is a poor lessen to teach any enemy, be they child or circuit.

Forgive yourself and your brain for this repetitive behaviour. But definitely meet head on any “snap-back” challenge. When you hear demands such as “craving” being made, remember it is not what it appears.

At every “snap-back”, you can replace/substitute with anything. Silence works for some. If you have the will to quit. It will still happen a lot.

Forgive frustration.

If in the earlier stages, or if quitting “for someone else” (which is also really always for you, but no more is likely needed on that point); replacement behaviours are even more useful. Anything, preferably something you can feel however. Do 11 push ups, for example. Or eat something high in sugar. Moving from one habit to another, in a weening process, has many benefits. Sure, there are those that would say, yes, more of the exercise is fine but not sugar: have some celery or a carrot stick.

As I say, anything can work, but sugar does allow a reward firing. Though I do like crunchy things. But we aren’t here to talk about me. Gum is another good one, as it can always be on hand. Train your mindfulness “peace space” (*talk to your therapist or Guru) to be related to the behaviour, ie as you have the gum, each and every time, relax all muscles, breathe deeply once, and forgive everything. That may sound a little bit hippie, and I hate hippies; but it works. Again, strong gum works better. So you can feel it.

It is all part of neural retraining. Compared to how long your brain has been trained to operate only with the drug; it actually works quite quickly.

Therapy and social replacement will be examined more completely in the next section.

DocJA (R), hc. (2013). Escape Velocity I. J Chron Lett Sc, Ed7. (19).

TA-73/3A-A-01/3-D

*Escape Velocity [EVII]

**Image: Deviant Art – ‘End of the Line’ by Marc Mebarak

About J.Chron.Ltt.&Sci. [JRR]

~CogSc (Humour); NeuroPsych; Philosophy (Death/Identity); Methods (Research); Intelligence/Investigation (Forensic); Medical Error~
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