I was moved to write a letter to a patient who completed an Accelerated Opioid Detox off Methadone last week. She is in the Post Acute Withdrawal (PAWS) stage, which can be very challenging. I have changed the name of the patient, but wanted to share the sentiments with you—or a loved one—who might be considering life without opioids, but are fearful of taking the plunge.

January 17, 2020

Dear Brenda,

I enjoyed speaking to you, and I hope you continue to feel better every day, if only in the tiniest of increments, and that you are able to appreciate and savor the progress you are making.

I have never gone through what you are experiencing, so all of my encouragement and advice come from being with people in similar circumstances for over a decade; witnessing their struggles, and celebrating their ultimate success to be finally free from opioids.

I heard something yesterday that immediately made me think about you and our conversation. It’s from BJ Fogg, author of Tiny Habits. He was being interviewed on a podcast I like called The One You Feed. The host is a guy in long-term recovery and he interviews all kinds of inspiring guests

Here’s the quote that made me stop and find a pencil:

"Hope and fear are vectors that push against each other and the sum of those two vectors is your overall motivation level. If you can remove the vector of fear, then hope will predominate and your overall motivation level will be higher.

Speaking with you, I could hear the fear in your voice. I heard your concern about never being able to feel "normal" again, to sleep well, to focus. Your feelings and emotions are all over the place, you are exhausted, and your beloved partner doesn’t know what to do. You are filled with remorse when you lash out at her because "she doesn’t understand."

Medications for sleep and anxiety are minimally helpful.

You finally wept when you told me you don’t believe you have the tools to deal with this situation.

Over the years I have come to learn from my patients that using mind- or pain-altering substances serves a purpose, even if this is not always well thought out, and even if only briefly. Over time, the substances often exacerbate the very conditions people used them for in the first place: anxiety, depression, loneliness, boredom, despair, pain.


I want to reassure you, Brenda, that after working with you and Carry, I am totally confident in your ability to not only get through this difficult phase but to be all the stronger for the struggle.

You told me you have lined up counseling, already found and attended a local recovery meeting in your area, and are keeping a journal. That is fantastic, and I urge you to continue to find like-minded people to help you through this phase. Celebrate every small step that is taking you toward your goal of a life free from methadone!

Remember what we talked about--all the ‘noise’ in your head can be acknowledged, but there is no need to latch on to any thought or feeling that isn’t serving your higher purpose, or that brings you angst instead of peace. Imagine your thoughts written in text on leaves, floating down a river. Here. Gone. Here. Gone.

It is normal to have some uncomfortable physical and emotional feelings.

Be mindful about turning a fleeting sensation into a catastrophic story in your head.

I urge you to release your grip on any fearful thoughts you have and focus on the present moment. You will find that nothing ever, in this moment, is lacking. You always have exactly what you need.

Reduce the fear, amp up the hope.

Keep in touch with us, we are here for you, but more importantly, You are there for You.

The Coleman Institute for Addiction Medicine has been helping people get off addictive substances for close to thirty years. We specialize in Accelerated Opioid Detoxes, which include hydrocodone products, oxycodone products, heroin, fentanyl, kratom, buprenorphine, and methadone, to name a few.

Our program is unique in many ways, perhaps most notably, it is one of the only outpatient detoxes in the country specializing in the use of naltrexone. If you’d like to know more about what we do and how we do it, please call our contact center at 877-773-3869.

Joan Shepherd, FNP