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Knowing & Understanding Your Addiction; a Lesson, an Essay

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This is a scientific & medically-based fact, no longer an "opinion" or a topic to be debated.  Regular use of an illicit, addictive drug, over a long period of time causes severe changes in the brain chemistry which affect not only psychological functioning but motor & physical functioning as well.  The changes are functional as well as structural.  The effects in the brain alter the normal chemical balance and even when an addict quits using their drug of choice, those effects remain and take months and years to be repaired, while some damage is sometimes permanent. 

It is because of this medical knowledge of long-term effects and changes in the brain, that addiction is now classified as a disease.  While the initial use of the drug is often times voluntary, even that is a weak argument for those who don't acknowledge medical breakthroughs, because the percentage of people who have voluntarily tried heroin for example, 90% of them will NOT become addicted to it.  It is the 10% that for some reason, which is now researched heavily, who DO become addicted and studies are just beginning to show why.  Other than being classified as a medical disease, other examples of breakthroughs in addiction treatment we have seen in just the last 10-15 years are Narcan which saves lives every single day in America, Suboxone/Subutex to be the 1st and only outpatient treatment for medication maintenance that isn't tightly regulated like methadone, which requires daily visits where Suboxone is more private, more convenient and only requires a 1 month visit, Vivitrol, the craving-reducing shot which also blocks any desired "high" if a patient decides to take an opiate, therefore acting also as a deterrent but without opiates in the medication itself, The Rapid Opiate Detox Treatment, which under sedation and/or anesthesia, the patient is injected with a course of medications to fully withdraw and detoxify the patient rapidly within an hour or more and when upon wakening, the patient has gone through their entire withdrawal, without having to experience the agony of weeks of indescribable pain and suffering as a "cold-turkey" withdrawal.  These are just some major medical advances in medicine for addiction we have seen occur in a very short span of time, with new ones being researched and tested currently.  

Involuntary addiction, usually referred to as "dependency" are for example people being chronic pain management patients who require the pain relief level of opiates, and then become dependent (just as those who voluntarily try opiates become dependent also) over time and even with just a very short time of regular use, as little as 1 month of daily use, even at low doses, the patient's brain and body functions rely on these drugs because the brain is drastically altered, which cannot be avoided or preventable. 

New research has just shown, that a study involving siblings who one or more were addicts, had significant abnormalities in the brain which non-addicted people did not have.  These abnormalities in the brain were found in the areas of impulse control and self-control in general, that were there before the person ever even started using drugs.  This information backs up long suggested claims that drug addiction and alcoholism is related to genetic factors. Researchers have known that the brains of people addicted to drugs differ from those of others, but it has not been clear whether this is a cause or effect of addiction. The new study, because it shows that siblings who aren't addicted share brain abnormalities with addicts, suggests the brain differences are a cause of addiction, rather than an effect of drug use, the researchers said.  "There is a biological basis why people suffer from addiction," said lead author Karen Ersche, a neuroscientist who researches addictive behavior at the University of Cambridge in England of the journal Science, about this study which was published February 2, 2014. "This study suggests that some brains predispose people to become addicted, should they decide to use drugs," Ersche said. "We need to find out how these nonaddicted siblings were able to resist using drugs."  The study also confirms previous studies' findings that if one identical twin suffered from addiction, that the non-addicted twin has a 50:50 chance at also becoming an addict.  It is believed that different experiences and their environment may be what causes one twin to initially use drugs while the other doesn't.  There are still studies looking into this but as for the brain images, the abnormalities exist and are present in both twins.  This evidence overall is further proof of the already documented data that equates addiction as a medical disease due to changes and abnormalities in the brain whther they are before or after intial drug use. 

But more and more studies are finding what so many believe and some research like this has shown, that the abnormalities are there before an addict ever uses a drug.  This should be proof enough that society should erase from their minds, their damaging and unfounded predjudiced opinions that addicts are weak-willed, without morals or bad people. 
 Knowing the changes that happen and how it affects you as an addict is important to realizing the severity of your disease as well as effectively recognizing what needs attention and focus in your treatment plan and recovery, especially in early recovery, so you know what to expect.  This book is meant to guide and serve you, teaching you the tools you need to work on yourself and work on your life in recovery in order to be successful, happy and healthy once again, as a supplement to the largely non-accessed behavioral and psychological treatment, whether you are on medication therapy or not.  Part of those tools include an important part of knowing your disease; what it actually does to your brain and how those changes to your brain manifest in your behaviors and thinking, until your brain is healed with continuous abstinence of your drug of choice, through recovery, sobriety and treatment. 
Most of the changes that occur are from neurological damage. 

Drugs tap into the brain's communication system and disrupt the way nerve cells normally send, receive, and process information. Drugs work in the brain by imitating natural neurotransmitters, chemical messengers in the brain.  Because of the similarity in chemical structure between drugs and neurotransmitters naturally produced by the brain, some drugs, such as marijuana and heroin, are able to "fool" the brain's receptors and activate nerve cells to send abnormal messages via the network.  They also overstimulate the reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure.  And nearly all drugs of abuse, directly or indirectly, activate this system. Some drugs, particularly stimulants like methamphetamine and cocaine, cause nerve cells to release abnormally large amounts of natural neurotransmitters or prevent their normal recycling, which is needed to shut off the signal between neurons. 

Over time, the brain adapts. In response to the overwhelming surges in dopamine, the brain adjusts by decreasing the number of dopamine receptors available– thus diminishing the function of the reward circuit. Drug addicts are compelled to abuse drugs to bring their dopamine function back up to normal, requiring ever larger amounts to achieve the initial dopamine high– an effect known as tolerance. Mixed with the lack of impulse control, tolerance is what casues the overwhelming and intense cravings when an addict is lacking the drug for too long, even a matter of hours from the last use, and causes them to do irrational things in order to access their drug again.  If too long of time passes and the user cannot access their drug, this is when we know withdrawal sets in which is excruciating, painful and both physically and mentally tormenting for the person.  That pain causes stronger impulses and cravings the longer one goes without the drug, leading to actions such as theft, that the person would never consider if not in that state of withdrawal. 

Long-term substance abuse also causes changes in other brain chemical systems, including glutamate, a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can cause impairment in cognitive function.  Drug abuse can trigger nonconscious memory systems. Conditioning is one example of this type of learning, whereby environmental cues, such as certain people or places, become associated with the drug experience and can trigger uncontrollable cravings if the individual is exposed to these cues, even without the drug itself being available.  Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. These changes are likely what drive an abuser to seek out and take drugs compulsively despite adverse consequences. 

When an addict discontinues the regular use of their drug altogether, and decides to enter recovery and abstain from their drug, many changes occur at this time because of the adaptation of the brain and your behavior and thinking from using drugs for as long as you have.  It can be a difficult time both emotionally, psychologically and physically as the brain is forced to now adapt to the LACK of the drug being regularly put into the body.  The lack of your drug of choice causes many symptoms and discomforts, on different levels of severity for each person and depending also on which drug.  But overall, no matter what drug was used, abruptly stopping the use of the drug will impact many body functions and alter your emotions as well.  This can reveal itself in what is known as "PAWS", or Post Acute Withdrawal Symptoms" which can make sobriety very difficult, mainly in the first few months and then as they reoccur for period of 2-4 weeks throughout the first year of recovery, however the symptoms can be slight or manageable, while others may experience more acute symptoms in a shorter period of time.  It shouldn't be feared if you know what to expect beforehand in early recovery.  

Post-acute withdrawal is a group of symptoms of addictive disease that occur as a result of abstinence from the addictive chemicals. In the alcoholic/addict these symptoms typically begin to appear seven to fourteen days into abstinence and after stabilization from the initial withdrawal or detoxification from the drug, typically being about a week long.  Many addicts after the initial physical detoxification, still experience immense difficulty.  This is something very important for loved ones of an addict to be educated about, because a non-addict usually believes once the drug is out of the system and the addict is off the drug for a week, that the addict should be "cured", "better" or "finished" with their addiction.  This belief can be harmful for the addict because it is entirely false.  The majority of the physical discomfort may be over, but there is a long list of other symptoms that persist and can be very challenging for the addict, for months to come.  Support during this time is crucial for the addict, as what they are feeling and experiencing is not "mental", it is very real and medically founded by damage to the nervous system and emotional regulation, which takes much longer to heal and recover from. 

Post-acute withdrawal is a bio-psycho-social syndrome. It results from the combination of damage to the nervous system caused by alcohol or drugs and the psychosocial stress of coping with life without drugs or alcohol.  Recovery causes a great deal of stress. Many chemically dependent people never learn to manage stress without alcohol and drug use. The stress aggravates the brain dysfunction and makes the symptoms worse. The severity of PAWS depends upon two things: the severity of the brain dysfunction caused by the addiction and the amount of psychosocial stress experienced in recovery.  The symptoms of PAWS typically grow to peak intensity over three to six months after abstinence begins. The damage is usually reversible, meaning the major symptoms go away in time if proper treatment is received.  With proper treatment and effective sober living conditions, it is possible to learn to live normally in spite of the impairments. But the adjustment does not occur rapidly.
Recovery from the nervous system damage usually required from six to 24 months with the assistance of a healthy recovery program. Recent research is showing that for some recovering people the symptoms of PAWS often occur at regular “moon cycle” intervals and without apparent outside stressors. Often those 30, 60, 90, 120, 180, and 1 & 2-year sobriety dates seem to be “triggering” times for PAWS symptoms to increase. People recovering from long term opiate and stimulant use often have PAWS symptoms for no apparent reason for up to 10 years after they have stopped using their drug of choice, but the symptoms are seldom and do not last nearly as long as they do in the first year of recovery.

Often PAWS symptoms appear to come and go without apparent reason and without any specific pattern. Individuals who intend to have consistent long-term recovery must learn to recognize these symptoms and learn how to manage them.  The most identifiable characteristic is the inability to solve usually simple problems. There are six major types of PAWS symptoms that contribute to this. They are the inability to think clearly, memory problems, emotional overreactions and numbness, sleep disturbances, physical coordination problems, and general problems in managing stress. The inability to solve usually simple problems because of any or all of these symptoms leads to diminished self-esteem. A person often feels incompetent, embarrassed, and “not okay” about themselves. Diminished self-esteem and the fear of failure interfere with productive living. The PAWS symptoms that contribute to the inability to solve usually simple problems are:

Inability to think clearly and poor concentration, memory problems and difficulty learning new concepts, emotional overreactions such as anger, sadness, anxiety, irritability, mood swings or emotional numbness, major sleep disturbances, physical coordination problems, and stress sensitivity. 

Difficulty in managing stress is the most confusing and aggravating part of post acute withdrawal. Recovering people are often unable to distinguish between low-stress situations and high-stress situations. They may not recognize low levels of stress, and then overreact when they become aware of the stress they are experiencing. They may feel stressful in situations that ordinarily would not bother them, and in addition, when they react they overreact. They may do things that are completely inappropriate for the situation, so much so that later on they may wonder why they reacted so strongly.  To complicate things further, all of the other symptoms of post acute withdrawal become worse during times of high stress. There is a direct relationship between elevated stress and the severity of PAWS. Each intensifies the other. The intensity of PAWS creates stress, and stress aggravates PAWS and makes it more severe.  At times of low stress, the symptoms get better and may even go away. When you are well rested and relaxed, eating properly, and getting along well with people, you will probably appear to be fine. Your thoughts will be clear, your emotions appropriate, and your memory all right. At times of high stress, however, your brain may suddenly shut down. You may begin experiencing thinking problems, inappropriate emotional outbursts, and memory problems.

If your thoughts become confused and chaotic or you are unable to concentrate, if you have trouble remembering or solving problems, you may feel you are going crazy. You are not. These symptoms are a normal part of your recovery and are reversible and manageable with abstinence and a recovery program.  If you do not understand that this is normal for early recovery, you may develop shame and guilt which leads to diminished self-esteem and isolation which creates stress and increased PAWS, increasing also, the chance of a relapse.  This is why it is so important to really know your disease and understand what to expect, so that you do not panic and are aware of what is happening and why.  It is a painful cycle that is unnecessary if you do not understand what is happening.

As your body and your mind begin to heal and as you learn ways to reduce the risk of post acute withdrawal symptoms, productive and meaningful living is possible in spite of the possibility of recurring symptoms.  Recovery from the damage caused by addiction requires abstinence; if a person has numerous relapses while attempting sobriety, the brain is not given proper time to be able to heal itself.  The damage itself however, interferes with the ability to abstain because of the damage to self-control, impulsivity and physical symptoms that can be very bothersome.

This is the paradox of recovery. Use of alcohol or other drugs can temporarily reverse the symptoms of the damage. If alcoholics drink, or drug addicts use, they will think clearly for a little while, be able to have normal feelings and emotions for a little while, feel healthy for a little while.  Unfortunately, the disease will eventually trigger a loss of control that will again destroy these functions.  For this reason it is necessary to do everything possible to reduce the symptoms of PAWS so that you can stay clean, manage stress and focus on being well again.   It is necessary to understand PAWS and to recognize that you are not incompetent and you are not going crazy and that the symptoms will occur less often and in a diminished intensity, making it easier to manage and to remain abstinent. 

Because post acute withdrawal symptoms are stress sensitive, you need to learn about PAWS and methods of control when stress levels are low in order to be able to prevent the symptoms or to manage them when they occur.  PAWS is what makes early recovery so sensitive to relapse and why it requires as much support and treatment as possible during this time for the addict.  Medicine can help such as replacement therapies like methadone and suboxone, as well as dual diagnosis treatment for depression or anxiety with medications prescribed by a doctor to manage those symptoms experienced during post acute withdrawal.  But as you can see the large number of these symptoms experienced for a long time, cannot be medicated away or helped with any medication at all, because they are emotional and behavioral. 

This is the part of addiction hardest to treat, since as I've repeatedly noted there is a large number of addicts, actually the majority of addicts, who do not have access to behavioral and emotional support or professional therapeutic treatment and this raises the risk of relapse when these symptoms are not addressed at all. 
In early recovery one MUST address these difficult changes in your behavior and emotions on your own, as what may be your only option, other than being able to actually access therapeutic treatment for emotional and behavioral symptoms.  Working on yourself and taking care of yourself, stopping to recognize why and what is causing you to react or feel like you are, recognizing what makes you feel like running or makes you angry; these are all things we don't do in active addiction. 
In recovery the way we behaved in active addiction, has now over such a long time, become habits and habits are hard to change, but not impossible to. It takes attention and work in order to do this by making a commitment to keep track of your emotions even in a journal and what happened prior to you having these dhanges of emotions to discover a pattern or certain 

Early recovery is when you can and should, use your time and energy to focus on finally addressing the emotions and behaviors that need changing. 
Changing the emotions and behaviors that went along with active addiction will increase your odds of success in long-term recovery and make it easier to abstain, managing the PAWS and having a more tolerable experience with your recovery. 

Our environment influences a large part of how we feel and how we behave during early recovery and one must take a close look and examine what is healthy for them and what isn't in their environment at home and at work or school as well as perhaps most importantly, your social environment.  We must make changes to our environment and who we surround ourselves with, which is something that needs to be addressed quickly.  If we don't change anything about our environment and only abstain from our drug of choice, we will likely be tempted towards a relapse and end up in stressful, unhealthy situations that are dangerous to our recovery efforts.  With addiction being such a deadly disease and a relapse after a period of abstaining, the most common contributing factor to drug overdose, this cannot be taken lightly and cannot be stressed enough. 

Part of changing our environment other than the people we associate with is how we handle stress and communicate with people close to us.  With tension often caused between you and your loved ones from your actions during active addiction, there is already likely some degree of tension in relationships, and topics that need addressing which may make you feel uncomfortable or ashamed.  Learning more effective ways to communicate can drastically improve your interactions and communication with your loved ones, making recovery less stressful for you.  Learning effective communication specifically for addicts in recovery, and knowing how to handle stressful situations to lessen the emotional response and therefore lessening the risk of relapse. 

There are hundreds of books and endless literature about all the research and studies involving the brains of addicts but the focus right now with the number of addicted people just in the United States must be on treatment and providing help for those that are currently suffering and facing enormous risks and fatality.  Drug addiction is a chronic, relapsing disease—like diabetes, asthma, or heart disease—and it can be managed successfully. Treatment helps people to counteract addiction's powerful disruptive effects and regain control of their lives. And just as with other chronic diseases, relapses are not uncommon. But relapse does not signal failure—rather, it indicates that treatment should be reinstated or adjusted to help the addict fully recover.

While there are treatments and luckily ones that have evolved in the medical community to help addiction, there remains no cure for it.  Recovery from addiction takes a long time, and while the brain heals slowly over an average period of 1 year of abstinence from the drug, the person must also address underlying medical and psychological issues as well. 
If these issues are not identified through behavioral or psychotherapy, counseling, support groups, medical testing and diagnostics or other support systems, then only one aspect of the disease is being treated.

Though help is available to identify and treat the non-neurological healing aspect of the illness, the tragic part of the disease relapsing is due to these avenues being tragically, currently inaccessible to the population of addicts and largely due to the incredibly high cost of these services and most providers either not accepting insurance at all or accepting insurance but charging additional fees or costs to the patient.  Another way these services are inaccessible is that many providers have incredibly long waiting lists. 
Both of these barriers to accessing crucial treatment for addicts is discouraging and causes addicts to either not seek help at all or only treat their physical addiction with medication therapy and not address the other aspects of their disease, increasing the risk and probability of relapse and overdose.  More people with addiction are unable to access these therapies than addicts who do, and can access the other part of the disease's available treatments. 
It is known through many studies over the years that without healing the non-neurological aspect of addiction, meaning the behavioral, environmental and psychological aspects, the person's rate of relapse is very high and almost certain to be likely.  While there are people lobbying for changes in their communities and states to make community resources more accessible, the crisis is still growing for those who are only able to treat the physical dependence of addiction. 

It is a fact that most drug overdoses that result in fatalities, occur in addicts who have had a period of sobriety and then relapse.  The cause is due to them grossly misjudging the amount or potency of the drug and therefore they end up taking too much at once, when their body is no longer tolerant of the level that has just been taken by the person in their relapse.  Treating relapse and preventing relapse is top priority in helping to solve the epidemic and crisis that is addiction and fatalities of addiction, both which grow in shockingly high numbers every year.  Having more readily accessible programs for therapy, counseling and internal medicine for communities at a lower cost or covered by community programs, would absolutely give people a higher chance to achieve long-term sobriety by being able to then treat all areas that are known to cause addiction and relapse.  It would offer addicts hope and provide them with the chance to achieve long-term sobriety and prevent relapses that lead to overdoses and deaths, which have so shockingly reached astounding proportions across the entire United States.   

Those with a dual diagnosis of bipolar disorders, depression or anxiety, need better access to treat those serious conditions as well, and greatly increase one's chance of success in recovery from addiction.  There are many changes that should and hopefully will happen across the country in many communities, but unfortunately for now, those who have addiction and want help have to settle for what they do currently have access to, which is mostly community-run social sobriety programs and groups, and of course pharmacological treatment such as methadone and suboxone.  But even replacement therapies like suboxone and methadone have barriers to access due to the high cost, which in some states is covered for addicts, but in others there is no assistance in obtaining this treatment.  Even with replacement therapy, the psychological and behavioral aspects are what truly need attention, time and great effort on the part of the addicts themselves to address whichever way they can. 

There are various behavioral parts of addiction and what the addict can do and change in their lifestyle and actions as well as thoughts and regulating emotions in order to set them up for a better chance at sobriety and preventing relapse as well as recovering from a relapse should one occur.  There is advice used by the top addiction centers in the country on communication, relationships, relapse prevention, spirituality, setting goals, handling stress and finding hope; all areas that must be addressed in order to treat that non-physical part of addiction.  Since this area seems to be the least treated area for addicts, I decided to dedicate my energy and time, not just by continuing to write as a way to spread education and awareness regarding addiction & recovery for addicts AND family members, but I've also been writing and putting together a series of recovery resources that will be published as a guide, as my next book, educating with practical information useful for any addict at any point in their recovery, which is a sort of "companion" tool for those who may not be able to, for whatever reason, receive outpatient & ongoing therapeutic, addiction-sustaining services such as therapy or counseling, etc. 

A helpful tool in recovery for addicts is to look at the whole picture of their disease of addiction and address all these areas one by one, effectively and beneficially to change one's attitude, behavior, responses and thinking so that you can live a fulfilling and rich life through recovery, without turning to drugs or alcohol to handle life's stressors. That IS the goal, is the way of living a clean & sober lifestyle and it is the only way to stay on the path of increasing self-esteem, bettering your life overall, meeting new goals, surrounding yourself with an encouraging, loving and helpful support system, and this is the goal of sustained recovery.  It is the reason to become clean and enter recovery.  It is living a meaningful life once again. 

If you are reading this then you likely know the devastating effects of addiction on not only the addict and society as a whole, but on the family members, loved ones and those closest to the addict.  It is a disease that affects everyone involved and can have devastating consequences.  An addict must acknowledge this affect of their addiction and come to a realization when deciding to choose recovery, that their addiction has indeed negatively affected many people.  For this reason, when in early recovery, an addict can become frustrated when loved ones are still suspicious of them or don't forgive them right away.  Unless the addict acknowledges what their addiction has done to people, this can be reason for relapse and a very short-lived time in sobriety. 

So knowing your disease and its effects is crucial when deciding to enter in recovery if you hope for a successful attempt.  Since we do indeed afflict consequences on our loved ones, we must accept that while we heal ourselves through recovery, it also will take your loved ones time to also heal from their wounds and eventually be able to trust you once again, if ever.  This is a first step to recovery.  As an addict we cannot force our loved ones to pat us on the back for achieving 2 days of sobriety and expect everyone we hurt to instantly be proud of us.  What is a source of pride for us, will indeed make our loved ones happy and relieved, but they have good reason to worry and be suspicious with the statistics of relapse or if you have relapsed in the past during recovery attempts.  Of course they are going to be suspicious, distrusting, cautious and still possibly sad or angry with how they have been affected by your addiction. 

An addict has to allow their loved ones to slowly process what is happening and changing in your life and take the time to heal and be able to be close to you again in the way you may wish.  It will happen, but it most likely won't happen as fast as you wish.  People will come around and eventually be proud of you and happy for you that you are achieving success in your sobriety and recovery, but you must be realistic that their emotions and worries, concerns and suspicions, won't change overnight.  Yes they will be glad you did seek help, because they care about you, but it will take time for them to be able to trust again and you must grant them that time. 
This is one specific area I have seen on forums and groups online for recovering addicts, over and over again.  In the beginning, we must be proud of ourselves and seek support from people who have experienced addiction and recovery, so that they can be proud of you too, if you need that extra support, but our family likely has good reason to be a little apprehensive about getting too excited, because they are in fear still for your life.  We must view it as love, that they are worried about you and although they may not show their relief or happiness that you have sought help and are clean and sober, inside they are praying that you succeed and will eventually be more open with you and show you that they are indeed proud. 

We also must acknowledge that those who have not experienced addiction may not understand how difficult it is to enter recovery and stop using.  There are many people who still view drug addiction as a choice, and even if a family member has been witness to your difficulty with addiction, that doesn't mean they understand how hard it truly is for you.  There is a long social belief that addiction is a moral failing and a choice, and even though science and medicine has proven it to be a disease, it is hard for people who have believed the opposite for so many years to accept that fact.  So this can also be a contributing factor to why family members or close friends don't see your recovery as the success that you view it as and know it to be. 

We cannot always or easily change engrained beliefs someone has had so long that they become one's permanent belief and stance on the issue and may not be open to admitting or considering that possibly the belief they've had for decades is wrong or that there is more known today that makes the subject and surrounding issues of addiction as a disease very clear to see and acknowledge, BUT very difficult to convince to those who won't be open to listening to the learned scientific and medical facts there are today about addiction.  That is okay and they should be allowed their own privacy and beliefs as long as it doesn't harm people.  SO since we can't just go out and change the entire stigma in a day, month, year or even decade, one must therefore keep their focus off other people and the focus must remain on YOU.  Your own healthy thoughts about your recovery and acknowledging your own success as well as seeking the support of fellow recovered addicts through support groups like AA or NA, online recovery groups or forums, loved ones who are very supportive of your recovery attempt and hard work, or people you know that are recovering addicts who understand what you experience and can offer advice, encouragement, motivation, support or just be there to listen when you need to vent.   As we become more confident in our sobriety and recovery, eventually your family will also have more confidence in you.  It just takes time and evidence of our commitment and effort, but you must accept that this process takes time for everyone and some longer than others.  Do not let that discourage you or distract you from knowing all you have accomplished.  
There are so many social impacts on loved ones and ways to handle conflict and how to change your response to emotional situations and conversations without becoming angry or resentful but rather learning and teaching yourself how to have patience and have effective communication skills in your relationships. 
When we are in active use, we are a different person.  Our loved ones become accustomed to that different person and it takes time to adjust to the sober "you" again.  It is as if they are meeting you all over again.  Patience is important, and you must be patient with yourself and your loved ones during your recovery. 

Recovery is never quite "achieved" but rather is a continuous, life-long commitment that you make each and every day.  You must focus on making the best choices for your recovery each day and do this for yourself and your own pride, not for someone else; NEVER for somebody else. 

Recovery IS essentially rebuilding your life from scratch.  Uncovering what made you pick up, what emotions trigger you, learning what led to those emotions requires long-term commitment and a lot of hard work. You must commit yourself to changing your behaviors; change your reactions and impulses and recognize and analyze a situation before acting on an urge or craving.  That takes time and effort to be able to do, but it is possible and will eventually become natural, giving you a great chance at staying clean and sober. 
Setting goals for your new life, finding hope and making changes, are all actions that must be taken to maintain recovery . 





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Erika Cormier, author of  the memoir, "As the Smoke Clears", understands first hand that addiction isn't always a "visible" disease.  She has dedicated her life to helping other women suffering from addiction and has drafted a bill to place caps on the high cost of outpatient addiction-related services.

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