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Lessons from Recovery

By John Schorling I have spent many years working with people with substance use disorders, including individuals with opioid use disorder.  I am continuously amazed by the resilience of people who are in recovery. Many can point to the events or circumstances that led them to stop using drugs.  It may have been the threat of losing their job, or getting arrested and sent to jail where they could not get drugs, or they may have gotten placed in a monitoring program where not losing their job or not going to jail was contingent on not using drugs. Fortunately, once they decide to stop, there are medications available to treat opioid use disorder that can dramatically increase the likelihood that people will not use these drugs, and that can also decrease their risk of dying of an overdose by 40 to 50%.  Over the past three years, over 100,000 people a year have died of drug overdoses, most of these due to opioids.  This is more than died due to motor vehicle accidents and gun violence combined. When an individual stops using illicit opioids, they have to learn how to live without these drugs, which can be very challenging. Often, their predominant way of dealing with difficulty in the past was to use drugs.  When they stop using them, they have to find new ways of coping. Those who are successful frequently learn quickly, and often incorporate mindfulness into their daily lives. A common situation in which this applies is dealing with cravings for opioids.  We all have opioid receptors in our bodies that bind the natural opioids our bodies make.  When people use drugs like fentanyl, the number of these opioid receptors can increase dramatically.  When they stop using, the receptors no longer bound by fentanyl cause cravings.  The medications that are used to treat opioid use disorder help reduce cravings but they often do not eliminate them.  So how do people deal with them?  They know what they feel like, and they know the thoughts that arise automatically in response, such as “I’ve got to get drugs now”.  Rather than getting caught up in their thoughts, they choose to do something else, an activity that places their attention elsewhere.  And they know that the cravings don’t last forever, that they are often short-lived, usually persisting for 15 minutes or less. Dealing with work stresses is another area where people commonly apply mindfulness. When they start working after stopping using opioids they often have a feeling of gratitude, grateful that they can even get a job.  Having a job has many benefits that they recognize.  One is that a job keeps them busy so they are not idle and possibly bored, thinking about how things would be better if they could get high.  Another is it gives them the opportunity to afford things they may never have had or have lost, like a stable roof over their head, or the ability to provide for their family, or to have a car to go wherever they want. Work can also be stressful, and they have to learn to deal with the stresses without drugs.  Rather than getting caught up in the negatives of their work, they often recognize what they do and do not have control over.  For example, if someone has to work with a difficult boss, they may feel that they are being treated unfairly, and they also know that they can’t control their boss’s actions.  If they have a challenging interaction with their boss, they understand the risks of just reacting, and know that they have to pause and choose an appropriate response.  Also, instead of perseverating over the unfairness of their situation, they may acknowledge that they feel it is unfair, do what they can within their control to deal with it, and move on. They recognize that focusing on the unfairness will only make them feel worse, and for them, focusing on negatives may have catastrophic consequences if they start using drugs again. Individuals with opioid use disorder who are in recovery often have to deal with major life stresses that many of us never face.  That they are able to do so successfully, and often with a sense of gratitude, is inspiring and can serve as an example of what’s possible for all of us.

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