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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by BSBD on April 1, 2008, at 13:08:20
I have a history of longterm physical, emotional and childhood sexual abuse lasting approx 14 yrs. There have been many other stressors involved including the death of my first child, the suicide of a previous lover (although we had not been involved for many years before it happened), and a traumatic divorce. I've made five suicide attempts, starting at age 16. I'm currently 38 yrs old.
I have been diagnosed with bipolar 2 disorder, PTSD, and borderline personality disorder in the past. I also have a diagnosis of chemical dependency.
I spent over six years in weekly therapy attempting to work on the trauma issues, but was unable to resolve them. I can talk about my abuse issue intellectually with anyone, but the moment it starts to get emotionally involving for me, I shut down. You can imagine how frustrating this was after six years.
Every time that I've been admitted to the psych ward following a suicide attempt, I've tested positive for substances and was subsequently referred to addiction treatment. I'm currently again in IOP treatment for drug addiction to opiates. I am not currently on any medication and am not in therapy, other than the addiction treatment which has never been successful in the past (due to my "inability to understand that all my problems are caused by drug use and that if I just stop using, everything will be fine").
I've recently been researching studies done regarding the phenomenon of endorphin release caused by PTSD triggers (such as therapy sessions) often causing numbing and inability to resolve those issues (which is what always happened to me in therapy, I shut down) followed by an endorphin withdrawal afterwards leading to using drugs to increase the endorphin levels. The problem is with getting anyone to see that this is more than just an addiction problem.
I noticed a clear example of this in myself over the weekend. Saturday morning's therapy session had something very intense happen and when it did, I felt that first rush of emotions, then I blocked it out. I switched over into this calm rational person and by the time I left there, I was literally high. I would not have felt any higher if I had taken drugs right then. I was floating. Within hours, I crashed, felt that restlessness and irritability coming on. So, I went and hung out somewhere that had always given me a bit of a rush before (skydiving is an interest/hobby and I just went and watched people skydive for a few hours). I left there feeling good. By Sunday morning, I was rock bottom.
There are times that I have no problems staying sober. I walked out on my last therapist in November 2007, mainly out of just frustration during the last session, and never went back to him. Within the following weeks, I quit using all drugs, alcohol, even smoking. I was able to work on rebuilding a lot of things that I had thrown away during the previous six months which had been very traumatic months for me. I can honestly say that I was doing well.
Mid February, I went on vacation and during that vacation, experienced something that in retrospect triggered me hard on my PTSD. Immediately upon return, I went off onto a binge, even using much harder drugs than I ever had, such as heroin. I even started smoking again. Everything came back, the suicidal thoughts, sleep problems, irritability, everything.
Every study I've read (and I've researched this an incredible amount in the last week) has indicated very poor recovery rates for addicts who are not treated concurrently for their PTSD as for their addiction. However, of course, "the issue is that I just need to stop using drugs". Okay, I get that. I've been clean for ten days now. Guess what kicked in this Sunday after all that other stuff? The urge to cut...something I haven't even thought about in four years. When I brought it up today, the answer was "that's common for addicts that self-mutilate. You are looking for a release."
Okay, yeah, exactly, but if the PTSD isn't resolved or at least dealt with, I WILL use again. I've been through this too many times to have any different thoughts about it. Their issue is that as long as I have addiction issues, then the PTSD can't be dealt with. It's a maddening cycle.
This can't continue. I can stay sober for now, for a while. But eventually, the PTSD *will* trigger me again at some point and I know that I'll be using again. This last event took me from reasonably stable to suicidal within a matter of weeks.
There's been some studies into using naltrexone during PTSD treatment to prevent that endorphin release and enabling the patient to remain "in the emotions" during therapy, but I've not been able to find a therapist that seems to have even heard of that.
I guess I'm just looking for other opinions on this. I'm just tired of being treated like there is nothing wrong except that I use drugs and just need to stop that.
Thanks.
Posted by ClearSkies on April 2, 2008, at 19:38:30
In reply to PTSD and addictions, particularly opiates (long), posted by BSBD on April 1, 2008, at 13:08:20
Hello, and welcome. Thanks for sharing your story with us. I have PTSD, am a recovering alcoholic, and am being currently treated for depression and anxiety, and panic attacks.
Although my therapist does not specialize in PTSD, she does appear to have a really comprehensive understanding of how delicate the balance is between my continuing recovery and the triggers that can send me spiraling down. After years of struggle, I no longer attempt to treat my PTSD with alcohol - during my early sobriety, I found the medication Campral (acampsrosate) to be particularly effective - have you ever heard of it? Perhaps it would help you too. It helped greatly with the tremendous anxiety that I felt in trying to string together more than a week or two of sobriety, and I took it for a year and a half before slowly weaning off.
You've done an awful lot of research about your own situation; I personally believe that it's not "just" about treating our addictions, or "just" about dealing with our PTSD that leads to a comprehensive recovery, but a holistic, whole body approach.
More often than not, that approach has to be cobbled together by us, the patient.
I found EMDR treatment to be of some benefit when I first started on my therapy journey, and might even revisit it in the future as it had such an agreeable outcome for me - you might find it beneficial as a treatment adjunct. I wouldn't throw out therapy based on your previous experiences, just because I've has some pretty inept therapists who did not help my recovery at all - I've had to be persistent in searching for the right therapist fit for my particular set of problems.
It's nice to meet you.
ClearSkies
Posted by Amigan on April 6, 2008, at 0:44:53
In reply to Re: PTSD and addictions, particularly opiates (lon » BSBD, posted by ClearSkies on April 2, 2008, at 19:38:30
Hi. I haven't got much to say, except that i also read about this endorphines production in PTSD and that one treatment option is an opiate antagonist such as naloxone.
Naloxone removes the emotional numbness from people suffering from PTSC, but perhaps it will aksi make the endorphin withdrawal harder. Perphaps a mixed agonist/antagonist would be a more proper option, i don't know..Now that i think of it, this state has some things in common with the bipolar disorder somehow...
Posted by Sigismund on April 6, 2008, at 14:40:31
In reply to PTSD and addictions, particularly opiates (long), posted by BSBD on April 1, 2008, at 13:08:20
>Okay, yeah, exactly, but if the PTSD isn't resolved or at least dealt with, I WILL use again. I've been through this too many times to have any different thoughts about it. Their issue is that as long as I have addiction issues, then the PTSD can't be dealt with. It's a maddening cycle.
>This can't continue. I can stay sober for now, for a while. But eventually, the PTSD *will* trigger me again at some point and I know that I'll be using again. This last event took me from reasonably stable to suicidal within a matter of weeks.
Do you have any idea of what might resolve or deal with the PTSD (apart from the passage of time)? Nothing comes to my mind, at any rate.
Opiate problems tend to resolve over time because the changes in brain function make the whole process less worthwhile. The problem is it takes so long (frequently longer than the life of the person taking them, one suspects).
>due to my "inability to understand that all my problems are caused by drug use and that if I just stop using, everything will be fine").
You must be pleased you have that sorted out. It took me 30 years (to sort out the opiate thing), but it will likely take me a lot longer to feel that everything is fine. Because everyhing isn't.
Posted by AnxiousAnnie on April 12, 2008, at 22:03:06
In reply to Re: PTSD and addictions, particularly opiates (long) » BSBD, posted by Sigismund on April 6, 2008, at 14:40:31
Posted by AnxiousAnnie on April 12, 2008, at 22:09:10
In reply to PTSD and addictions, particularly opiates (long), posted by BSBD on April 1, 2008, at 13:08:20
I could write a book to your post.
I agree, I am searching holistically for ways to overcome my PTSD, and it flared up two years ago after an inept therapist traumatized me even more and I disossiated.
Pharmaceutically, have you tried Suboxone or Tenex?
Tenex can sometimes help nightmares in PTSD if you get them, and Suboxone has saved my life.
You also stated,"....There's been some studies into using naltrexone during PTSD treatment to prevent that endorphin release and enabling the patient to remain "in the emotions"..... "
YES! Rehab taught me that, and the Suboxone combined with another medication improved my quality of life significantly, unfortunately, I moved back into the same house where I get triggered (bad choice) and am trying to get back on track. EMotionally I decompensated horribly.
Anyway, I wish I could have been of more help, I am an addict and dual as well, it's finding those professionals who will and do take us seriously that's the challenge.
Have you heard of DBT?
Posted by BSBD on April 12, 2008, at 23:16:25
In reply to PTSD and addictions, particularly opiates (long), posted by BSBD on April 1, 2008, at 13:08:20
Thank you for all the replies. Yeah, I've done a lot of research into this because I'm at the point where I feel my life depends on it. I had only been using for six weeks this time when I woke up one morning and realized that I was either going to die that day or I was going to have to reach out for help again.
I'm impressed that so many people have heard of using naltrexone in PTSD treatment. Unfortunately, I haven't found a doctor and therapist willing to go that route. The two that I've managed to talk to about it and have heard of it are both unwilling to do it right now. I'm being told that they are concerned about me being unable to handle what may come up. Right now, I'm not able to handle what's *not* coming up.
I have 21 days sober today and I finish treatment on the 17th. I finally was able to speak to the hospital psychiatrist overseeing my case. He was very eager to start me on meds, named off all the mood stabilizers and I've been on all but two he named. Then, I supplied him with a list of everything I've taken which was a lot more comprehensive than the list he gave me. I'm just not willing to go back on meds right now. I've had absolutely no luck with psych meds in the past. I've been diagnosed with the BPII since I was 22 and I've learned how to manage it pretty well without meds. I've only had three full blown manic episodes. I tend to run between hypomanic, mixed and bottom of the pit. He gave me a referral to a therapist that specializes in trauma work and I can make an appointment with her as soon as my IOP is finished. She does EMDR, btw.
I've been on a roller coaster this time though. I know a lot has to do with outside factors. I'm a nurse and my license is suspended due to all of this. I have to go before the Board on the 23rd to see if it will be reinstated now. I'm flat broke, have bills coming up that I have to pay, and I'm having a hard time even putting gas in the car, along with buying groceries.
Not to mention, I'm depressed as hell right now.
A friend was just diagnosed with a very ugly disease early this week. I'd never used with him, but this city just isn't that big. So, like any good procrastinator, I sat on it for five days, told myself it wasn't possible, told myself it was very possible, and then made an appointment for some blood tests on Monday. So, I'm nervous about that too. Yeah, especially as a nurse, I should have known better and I did know better. Addiction kills and not just by overdose. It's one thing to see the statistics in the news, but something different entirely when a friend that looks very healthy is standing in front of you telling you that they've just gotten some of the worst news possible.
Thanks again for the help and advice. I appreciate it.
Posted by Gmill on July 13, 2009, at 19:25:21
In reply to Re: PTSD and addictions, particularly opiates (long) » BSBD, posted by Sigismund on April 6, 2008, at 14:40:31
Hmm, My PTSD has come with alot of issues including opiate addiction. I am now on Methadone 60mg daily however my PTSD is not any better and feel that I traded one drug (Percocet) for another being Methadone. I have triggers that I can't describe or know why they cause me to relapse into my PTSD but it sux. I also take Lexapro for depression and Vyvanse for ADHD. The Vyvanse helps keep my mind from wandering and keeps me focused on one thought at a time. This is a hard hurdle to jump and so far have just fallen and stuck in the same spot day after day. I am now unemployed, no health insurance and due to my past health issues cannot be insured, facing foreclosure, etc.
I just wish their was a miracle that could put all of us sufferers back on track and in the game as it sux sitting on the sidelines of life wondering what my next move will be.
This is the end of the thread.
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