I wrote about Ken in an earlier blog titled "Restoring Energy After Opioid Withdrawal." At that time, Ken was 5 weeks out from completing an Accelerated Opiate Detox off high doses of opioids, including hydromorphone and fentanyl. His energy was beginning to return, but it was still a struggle.

Checking back in with him earlier this week, I was gratified to hear that he is doing beautifully, now approximately three months post-detox. He feels that he is about “90%” back to his normal energy levels and is sleeping at least seven hours a night without the use of medication. He says perhaps the most helpful thing he has done in this early phase of his recovery was to create and commit to a morning routine for himself.

“Waking early to work toward personal goals is another whole world from waking early because I was getting sick and needed pills.”

He starts early, at least an hour before anyone else in the family rises. His practice includes reading some inspirational literature—some of it recovery-based, some of it more religious or spiritual in nature, keeping a journal, and itemizing priorities on his Values In Action sheet.

“My journaling is not necessarily profound stuff,” he says, “but knowing this is for my eyes only, I can really dump what’s in my head onto the page. Sometimes I’ll write about an issue I’m having with one of my kids or my wife, or sometimes a work situation. Often I’ll write about what I’ve read that has moved or inspired me. I’m at the point that I miss it if I don’t do it. I actually look forward to it.”


UNDERSTANDING ACCELERATED OPIOID DETOX


The other practice Ken has incorporated came from a suggestion I made when we first met and I was struck by the shame and regret Ken expressed about the "lost opportunities" from his dependence on opioids.

“One of the worst things for me about taking pills was how I robbed myself, my family, my friends, and my career of living up to my potential, being present, and being my best self. It was such a selfish and destructive place to be…”

I directed Ken to the Values in Action website which prompts the participant to complete a free survey that ranks one’s character strengths in order of their strongest to weakest (there are twenty-six in all). Ken’s Top 5 were Curiosity, Forgiveness, Love of Learning, Leadership, and Hope. I then suggest making a table, putting these top five strengths across the page horizontally and the five most important life roles in a vertical column on the left. For Ken, these are Husband, Parent, Friend, Employee, and Seeker (this encompasses his spirituality and his recovery). From this table, he created a grid with 25 boxes.

“I took each one of my top 5 character strengths paired with each role and came up with as many specific actions I could take to use my strengths in the service of who/what is most important to me.”

He gave me a couple of examples. In the Love of Learning/Parent box, he made the commitment to partner with his son on the robotics team. In the Hope/Seeker box, he added two AA meetings and a SMART recovery meeting each week to his schedule. In the Leadership/Husband box he suggested to his wife the idea of planning a novel $30 or less "adventure" within a 50-mile radius of their home once a month.

Ken is also incorporating regular exercise and healthy dietary changes into his regimen, as well as meticulous sleep hygiene.


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Do all these activities actually help to restore energy after an opioid detox?

We emphasize to our patients that an accelerated or rapid detox is not a "magic wand" that will restore them immediately to the functionality they enjoyed prior to using opiates, but healing absolutely happens.

To emphasize this point, we often pull out a laminated image of several brain slices scanned by the National Institute on Drug Abuse (NIDA). It portrays a normal brain rich with dopamine, and a brain which is completely depleted of dopamine due to drug use. The final set of brain slices depicts the dopamine beginning to be restored at about four months when no external sources of dopamine have been introduced. The estimate is that it can take about a year for the brain’s dopamine to be restored back to normal levels.

Will a person feel horrible that whole time?

Not at all. Energy increases and sleep generally gets better.

Working with patients across the spectrum of dependence, detox, early recovery, and ongoing recovery, I have come to see that energy levels are subjective and the time it takes to feel “normal” again varies from person to person and depends on many factors, including age, general physical and psychological health, and attitude. To me it simply stands to reason that fueling your physical machine as well as you can make sense; this includes good food, plenty of sleep, and regular exercise.

Intentionally cultivating a life in service to your values may or may not restore your dopamine more quickly, but there is no question that it can infuse the potentially difficult stage of early recovery—and the joy of ongoing recovery--with profound meaning.

If you are going to go through the inevitable discomfort of opioid withdrawal, why not imbue the whole process with something meaningful for you?

I will continue to stay in touch with Ken and who knows? He may be our next guest blogger.

Please call us.

Joan R. Shepherd, FNP

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