The 4th and final law in James Clear’s Atomic Habits refers to the final part of the habit loop, the reward. In order for a new habit to form and be sustained, any reward must be satisfying.

The difficult thing about this step speaks to our biology and evolution. As our earliest ancestors learned to survive predators, weather, famine and drought, acting in the present rewarded them, often quickly. This type of environment is called an immediate return environment.

Leap forward to 2020 and consider this. If we save a few dollars from a monthly or biweekly paycheck, we might get to retire someday. If we start a 529 account and diligently add to it, our child’s college may someday be paid for. If we don’t eat those sausage, egg, and cheese biscuits every morning, we may prevent visceral fat from forming around our organs and prevent heart disease. All these examples refer to the delayed return environment in which we live.

But in some ways, our brain hasn’t caught up with the changing times. Our brain really, really likes a reward. Now.

The Trouble With Instant Gratification

The ability to delay gratification has been well studied. And, no surprise, in order to obtain success in almost any realm of life, delaying gratification has to happen. At some point, if you want to fit into those trousers, you have to say no to late night eating. To get the grades, you have to do your homework. To write your book, you have to turn off Netflix and begin.

So how can we apply this to a substance use disorder when a brain has been hijacked by the unparalleled pull of an immediate dopamine response? How can anything else possibly be anywhere near as rewarding as the effect of the drug?

There is science and there is grace.


Detox and Recovery is More Than Just Science

The use and subsequent abuse of heroin wreak havoc on the normal chemical functions of the brain. The brain essentially goes into overdrive with these pleasurable chemicals and someone’s grasp on reality begins to fade after prolonged exposure. When the body starts to come off of heroin an immediate lack can be felt and feel terrible for the user. This results in a dangerous cycle of heroin abuse.

At the Coleman Institute for Addiction Medicine, we see it all the time. The bliss, the gratitude, the humility, the self-pride (in only the best way) as our patients begin to tentatively claim the identity of a person in recovery. When they are at last able to strip off the chains of addictive substances that have kept them locked in their personal hell and, as Dr. Coleman often speaks about, learning first hand about the difference between pleasures and gratifications.

There is almost a child-like awe as people in recovery see the world through this different lens. But it can only happen when the brain can get off the substances to which it has become physically dependent and to which it has developed a tolerance. This is where our program is so powerfully effective.

Our Patient-Focused Approach

Our Accelerated Opioid Detox process actively removes the addictive opioids from the receptors where they are attached within the body. These include pain medications such as hydrocodone and its various formulations, Opana®, Dilaudid® Roxicet®, methadone, and morphine products. We also detox people from street drugs such as heroin, fentanyl, and even kratom.

A growing number of people who have achieved some stability in their lives and wish to stop taking buprenorphine also seek our detox to assist them in getting through the rather protracted withdrawal that inevitably comes with this type of long acting medication.

Our patients find they are more comfortable than expected while the detox process clears the brain's receptors of the substance they’ve been abusing. A support person who is invested in recovery and being with their friend and patient is also very important to help someone see the process through.

Make Sobriety Your Reward

A book I often recommend to family members who have a loved one struggling with addiction is Jeff Foote’s (et al) Beyond Addiction. I’m sure now it was the sub-title that made me pick it up to begin with: How Science and Kindness Help People Change.

If I was asked what we do at the Coleman Institute in 10 words or less, I’d say “We help people using Science and Kindness.”

Our elegant detox, tweaked and improved and modified over more than twenty years by Dr. Coleman and all of us he has trained and taught, will get you off your opioids. We specialize in using naltrexone to populate the receptors, taking away the urge and the ability to use opioids, thus freeing our patients to enjoy a whole different spectrum of rewards in the one “wild and precious life” (thank you, Mary Oliver) we are dealt.

A young college student that recently came to us for help told us how happy they were to feel the joys of completing semesters again with their peers. They were no longer in a haze and felt confident to return to learning and completing assignments with fresh ideas, eager to start their career. The weight of the shame that came with their use disorder no longer was center stage in their life.

If you are in a place where you want to appreciate a different kind of reward, creating new habits, ready to embrace the long-term gratifications of keeping a promise, honoring a commitment, caring for your own body, and for others in your charge, we can help you get started. Give our office a call at 877-773-3869.

This is the fifth post of a five-part series. Check out the other posts in this blog series here. PART 1 | PART 2 | PART 3 | PART 4

Joan Shepherd, FNP