Guest Blog: Understanding Depression During Addiction Recovery

Note from Josh: While I take an extended break this summer, I wanted to provide some kind of content, so Patrick Bailey was once again nice enough to contribute several entries you’ll read over the next few weeks.

By Patrick Bailey

People who have gone through withdrawal or have witnessed someone suffer because of addiction understand how difficult it is. Besides the physical discomfort and pain, people in this process suffer from devastating depression that makes the recovery even more difficult.

Depression is a mental illness that can affect anyone and anywhere in the world, even those in rehabs. According to the report released by the Center for Disease Control, 10 percent of physician’s visit is because of depression. The World Health Organization reports that it is the leading cause of disability.

Depression is a mental illness that can happen anytime. In fact, it often strikes during recovery from alcohol or substance abuse and addiction. The symptoms often show during the first few weeks or months of the recovery phase. It is therefore essential that the treatment facility, be it a regular type or a luxury rehab in California, offers dual diagnosis treatment in order to effectively provide care should depression happen during recovery.

Causes of Depression During Recovery

There are many factors that could cause depression during the addiction recovery process. This includes the following:

Post-acute withdrawal syndrome

Post-Acute Withdrawal Syndrome or simply PAWS is the usual phenomenon related to recovery. Depression can function as PAWS and commonly happens in the days or weeks after symptoms of acute withdrawal died down. The symptoms of acute withdrawal often coincide with detoxification and linger until the first few weeks of recovery. On the other hand, depressive symptoms can last for months during the recovery stage.

Changes to the brain related to addiction

During addiction, the brain is affected by alcohol or drugs. When you go to a rehab or a treatment facility, you are treated. As a result, your brain adjusts to the effects of the substances by decreasing the production of neurotransmitters that give you the high or feel good sensation. This includes dopamine, GABA, and serotonin.

These neurotransmitters are responsible for modulating your mood or simply tell you how you should feel. When these chemicals are at their optimum levels they can be translated as a positive outlook or a good mood. When these neurotransmitters are at their lowest levels, this could manifest as depression.

During the early stage of recovery, when the brain is still adjusting to life without harmful substances like alcohol or drugs, depression can happen due to low levels of dopamine, GABA, and serotonin. This usually happens approximately 90 days without drugs or alcohol. A brain functioning lower than normal and producing lower levels of these neurotransmitters can show symptoms of depression ranging between mild and severe.

Dual Diagnosis

Dual Diagnosis has a higher chance of occurring to people with substance addiction. Although there are also other factors at play such as family history. Usually, an untreated dual diagnosis like bipolar disorder, major depression, and other depressive mental issues may be the reason for depression during recovery. After all, there is a strong link between alcoholism and dual diagnosis as well as depression and substance addiction. Several studies show that many cases of substance addiction are due to the patient’s effort to numb the pain he is feeling.

Feelings of despair

Most patients undergo the stage where they grieve for the loss of drugs or alcohol in their life. This usually happens at the start of the recovery process. Letting go of your old habits or addiction, however crucial to your well-being, can still cause you to feel a sense of loss. In addition, emotions that were once repressed by alcohol or drugs can suddenly arise causing sudden negative changes in your mood.

Symptoms

During the addiction recovery stage, it is important to be aware of the symptoms of depressions. Signs can include the following symptoms that could manifest alone, or all at the same time:

  • Persistent emotional numbness or being in a sad, empty, or low mood
  • Recurrence of negative thoughts
  • Irritability
  • Restlessness
  • Anxiety
  • Fatigue
  • Difficulty to focus or concentrate
  • Changes in appetite (eating remarkable more or significantly less)
  • Having trouble sleeping, oversleeping, or staying asleep
  • Lack of motivation for hobbies that you once loved
  • Feeling of worthlessness
  • Frequent feeling of being guilty

If you or your loved one is experiencing or manifesting any of the symptoms listed for a couple of weeks or more, consult a healthcare professional about this.

Risks of Untreated Depression

Clinical depression that goes untreated and allowed to progress can compromise your recovery in rehab centers, treatment facilities, or wherever you are admitted. This is applicable especially during the first few weeks of the recovery stage when cravings are at their strongest. Negative emotions like anger, grief, sadness, feeling of helplessness, can trigger anyone to go back to their old habit.

There is also a great chance that the patient will have the urge to escape the facility because of the painful situation he is undergoing. Patients usually report ebbing of suicidal thoughts. The worst thing that could happen when depression happens during recovery is drug or alcohol relapse. Going back to alcohol or substance at this stage could have fatal results because of the high risk of overdose and deadly health effects.

Patrick Bailey is a professional writer mainly in the fields of mental health, addiction, and living in recovery. He attempts to stay on top of the latest news in the addiction and the mental health world and enjoy writing about these topics to break the stigma associated with them.

Why Seek Conflict when Recovery is Going So Well?

Revolutionaries change the world. For better or worse, they leave their impact on the political, physical, cultural and/or social environment in ways they may not have even intended. They can be evil like Hitler, gifted like Shakespeare or unknown – like whoever started that goofy dance all the kids are doing where they swing their arms in front of them and behind them while swaying their hips. That said, I know being a revolutionary is absolutely counterproductive to my recovery.

For the first 30 years of my life, I told myself that I was put on Earth to have some kind of long-lasting impact that would be felt by everyone far and wide. By my mid-30s, that level of narcissism had settled as I decided I only needed to be known by everyone in a 25-mile radius around me.

The ironic thing is, I achieved it. Whether it was through my successful regional magazine, a film festival I co-founded or because of serving in local political office, I reached my goal of having just about everybody around me know who I was, and I loved nothing more than when someone came up to me to tell me what a good job I was doing.

I loved it even more though when somebody would come up to me and start an argument. I was the kind of person who, whether you did it to my face, in social media, or the local newspaper, I would dig in my heels and fight you word-for-word until I won whatever battle I thought I was fighting.

I thought I was a revolutionary. Whether it was introducing new ideas to the community in my magazine, discovering new filmmakers or creating city policy, I felt like it was my place to change the world and if that came with conflict, bring it on. I was going to win…or at least convince myself I had.

Today, instead of fashioning myself some sort of regional revolutionary, I actually avoid as much unnecessary conflict as possible. I haven’t had social media for about five years, first as a condition of bail and then probation and I don’t anticipate myself ever going back. I need neither the attention a picture on Instagram will get me, nor the long thread of responses as I argue some political or social point with my “friends.”

I’ve learned that when it comes to this kind of conflict, there is very little that I’m going to be able to do, either about someone’s opinion, or about whatever it is we’re arguing about. I completely understand why there is such support for Donald Trump, and I completely understand why there is such contempt, but I’m not going to get into a discussion about either. Whatever happens with Donald Trump, my opinion has no effect on his decisions and changing someone else’s opinion these days is just about impossible, no matter what facts or statistics you bring to the table, so why bother?

I’ve also become the same way with television and movies. Why do I want to get emotionally involved in something that is going to upset me, whether there’s a positive resolution or not? The other day, I happened upon the reboot of Wife Swap and it didn’t take me long to come to the conclusion that it was just about setting the audience up to root for one set of parents over the other, depending on what your beliefs and background are. I don’t want to get upset watching what I think is bad parenting. I don’t want to get upset watching people fail at running restaurants, bars or whatever the premise may be. I also watch far less sports than I once did.

It’s not just “reality” TV. I’ve almost completely turned away from dramatic TV shows and movies. I don’t want to see criminals be put in jail, nor get away with it, even if I know they’re just actors. I don’t want to see people lose loved ones or relationships not work out, even if it’s fake. Unless I’ve seen the movie and TV, so it’s lost its emotional punch, I avoid programming that features conflict as entertainment.

Perhaps this means that I’m running from the world’s problems and great art. At this point in my life, with my recovery going so well for so long, I’m OK with that accusation. Regardless of my opinion about the death penalty or abortion, I’m not going to be marching for or against it. That kind of energy, on either side, isn’t going to help me keep things on an even level. I’d rather see an episode of Everybody Loves Raymond or The Office that I’ve seen 10 times and leaves me feeling amused – or at worse, not feeling anything at all.

I think that I used alcohol and porn to let me escape my need of being a revolutionary, if only momentarily. I used them to bring me down from the emotions I caused – and needed — while creating conflict. When those needs disappear, it’s a lot easier to handle recovery.

‘Radical Acceptance’ Has Been Crucial to My Successful Addiction Recovery

One of the more important tools I developed in recovery has been the practice of radical acceptance. I was once called out for not having any radical acceptance ability when I was in rehab and it forced me to reflect on the accusation.

Several of the residents were allowed to attend an “outside” 12-step meeting, meaning they went to a Narcotics Anonymous meeting off the rehab property with regular community members. On their way back, they stopped off at a store and bought candy and energy drinks, which were both forbidden at the rehab. Their car was searched upon return and the contraband was discovered.

The next day, at our large group morning meeting, one of the counselors told us because of the actions of those four residents, all visitor’s passes would be cancelled the following weekend.

A few of the residents who had family or friends visiting got visibly upset and/or angry.

“This is meant to make you all accountable to one another,” the counselor told the group. “It’s a skill you need to develop. If you were in an office and one of your co-workers was flaunting the rules, your co-workers would come together and set them straight.”

I had always thought I had an overdeveloped sense of justice/injustice, and it was going off like a light on top of a firetruck. I couldn’t stand to see many of my friends denied visits with their families.

“Your rationalization is bullshit,” I said loudly.

“What is that, Mr. Shea?” the counselor asked.

“That’s a pathetic rationalization. First, if we were co-workers, that person would get fired. The entire team wouldn’t. Sure, we could complain to the boss about them, but none of us even knew what these guys did. Second, making each other accountable isn’t actually the way the world works. That’s why we have police and the legal system. We don’t punish all of society for one person’s wrongs.”

“Mr. Shea, do you family visiting you?” the counselor asked.

“No, they’re all in California or the northeast. They’re not flying to Texas to see me,” I explained.

“Then why does this particular situation concern you?” she asked.

“Because it’s not fair,” I said. “It’s not fair to the people who have family and friends coming.”

“Yet none of them are talking,” she said. “It’s you, who doesn’t even have a stake in this.”

“Whatever,” I said, and let it go, seething silently.

It kind of bothered me none of the people affected spoke up. It bothered me even more when a few hours later, I saw them joking and laughing with each other – and the counselor who delivered the news. It dawned on me that I was more upset about a situation that had no bearing on me whatsoever, than people who were directly involved. Something didn’t make sense about it.

Later that day, I sought out that counselor and told her that while the (in my eyes) unjust punishment was still bothering me, the others seemed to move on, and I didn’t understand how they could just do that.

She told me that she knew I believed I had a strong sense of justice and injustice, but she recognized it for what it was. It was really about power and control. I disagreed, but she pointed out as long as it was my allies, I was fine with other people in control, but the moment someone had it and I felt threatened, I confused it with injustice.

“You know you’re probably going to see a little jail time for what you did, right?” she asked.

“I don’t know,” I explained. “Technically, I already pled guilty, but when I get home, they’ll look at the fact I went here and to another rehab for alcoholism and that I’m in therapy…”

“You’ll probably do 6 to 12 months,” she interrupted.

“My lawyer is hoping for no time,” I said.

“They always hope for that, and I hope you get no time, but if you do, be prepared that there is nothing you can do about it,” she said.

I looked at her somewhat blankly not wanting to admit she was correct.

“Do you know why none of your friends are still freaking out about their visitors? They’ve learned to practice radical acceptance. That’s where sometimes, no matter what happens, you’re not in control and you just have to accept it and move on.”

It took some reflection, but I was able to recognize plenty of times in my life that I tried to manipulate a situation I didn’t want to accept under the guise of injustice. I also recognized how many times I ended up begrudgingly accepting something I couldn’t control, and how when I finally let it go, it rarely stuck with me very long.

As I’ve made my way through recovery, I’ve done a lot of reading about radical acceptance. That counselor simplified the concept. For me, what’s it really about is the pain and suffering that comes from not being in control.

When I don’t let something I can’t control go, I suffer more pain than if I just moved on. Refusing to accept the pain by refusing to let things go just brings additional suffering, and who really wants that?

About eight months after my conversation with the counselor, I got a sentence of nine months (of which I served six.) As the judge was reading her verdict, a bit of a calm came over me. I now knew what my punishment would be, and I was at peace with it because there wasn’t anything I could do about it and it would be a waste of time to try.

Radical acceptance doesn’t mean being lazy. It doesn’t give an excuse to not standing up against the real injustices of the world, but for people who were power-hungry control freaks like I was, it’s a way to gain perspective.

 

Is it Possible for an Addict to Go From “Recovering” to “Recovered?”

If you’re reading this on the day I wrote it, April 2, 2019, today marks five years of sobriety from alcohol. I also count this as my sobriety date from pornography, although it technically was a few days earlier. If you would have ever told me I’d go five years without either of my nearly life-long addictions, I’d have said it could only happen once I was put in the ground.

I won’t be attending AA to pick up my five-year chip. I believe I took from the program what I could in about six months of attending meetings. One of the things that I questioned at the time, and question even further now with so much sober time behind me, is if their belief that alcoholism is an ongoing disease and people never truly “heal” or completely “recover” is accurate for every addict.

I have no question in my mind that I was addicted to pornography and alcohol. They were my go-to vices when I needed to curb anxiety and stress for two decades. Despite negative consequences and a desire to stop, I didn’t until the law intervened. For me, being told I’d be thrown in jail (first on bail, then on probation) was the incentive I needed to quit.

I’ll admit, the cravings for porn were strong that first year and the cravings for alcohol were just as strong for around three years. Today though, unless I’m writing for this blog or giving an interview on a podcast, thoughts about using are not there. It’s just not a part of my everyday thinking anymore.

I think it’s healthier for me not to attend multiple meetings per week where discussions of alcohol and pornography are the focus. I appreciate the newcomers who are on the verge of falling back into that world of addiction, but I’ve met so many people with long-term sobriety who didn’t take the 12-Step route to know it can be another road to success.

I spent years (and continue to attend) in therapy, learning what happened in my life to contribute to the addictions starting. I have also spent years carefully crafting a new life where my routines are different, my motivations are different and I dutifully pay attention to my mental health.

So, am I still a recovering addict? According to most of the messaging, yes. I’ll never actually “recover”. Can one be an addict yet not actively participate in their addiction, nor having cravings? I’m not sure. Someone who played professional baseball from 1970 to 1984 is not still a baseball player. Someone who stopped smoking in 1997 is not still a smoker. Someone who spent their single life as a womanizer, but remains devoted in marriage is not still a philanderer. So why am I still an alcoholic and a porn addict?

I think the answer for most is, “It’s safer to consider my addiction as an active, living thing instead of a behavior of the past. I’m just one bad choice away from being back there.”

I understand that line of thinking, but aren’t I just one bad choice away from being a heroin user or starting a gambling addiction? We’re all just one bad choice away from ruining our lives, addict or not.

I believe addiction is a disease. It’s been proven by science. But science has also proven there are many diseases that people recover fully from. Is it possible addiction is one of those diseases?

I’m not completely there yet, but I have a feeling at some point, there is going to be an evolution in my mindset from “recovering” to “recovered” and I’m not worried about it being the slippery slope that returns me to the addictions. While I hopefully will always educate and inform about the dangers of addiction, I think the personal danger can dissipate to nearly nothing over time for many people.

Maybe this is just a matter of semantics. We love to label things in our society and we also tend to catastrophize for the worst-case scenario. When I was in rehab, the program was geared the same toward me, who needed only one trip each for alcohol and porn, as it was the person who had been 12 times and never been successful. I realistically probably didn’t need the same level of care that they did.

If constant self-monitoring and keeping your addiction top-of-mind, even after a decade, is what you need to stay sober, then please, fight the daily fight. I don’t want anything I say to dissuade you from continuing on with a program that works for you. I’ll never say that I wasn’t “really” addicted because I don’t need to white-knuckle it day-to-day anymore.

I also think it’s OK if you’re not struggling day-to-day. I don’t think it minimizes your battle and I don’t think you have to apologize for a recovery that the mainstream doesn’t acknowledge. I think it’s actually the place that most addicts strive to arrive at. I’m here, and I’m grateful.

Yes, Recovery Does Get Easier

While porn addiction isn’t exactly a happy topic, I feel like I sometimes tend to be about doom-and-gloom, often specifically looking for negative statistics to show what a problem the addiction is, and will become in our society.

I rarely talk about what it’s like for me today, nearly five years into recovery. For those wondering the big question “Does it ever get easier?” I’m here to tell you that yes, it does, but you have to find the way to make it easier.

I cannot say enough wonderful things about cognitive behavioral therapy. If you have a behavior, even one that reaches an addictive level, I urge you to seek out a therapist who specializes in CBT.

When I was at both of my rehabs, there were the naysayers and people who didn’t want to be there. I remember one time, there was an especially mouth drug addict. He was young and it was clear his parents forced him to be there or he’d get cut off. There are always a few those at every rehab.

“You’re just here to brainwash us!” he once blurted out to a clinician who was running one of our group activities.

He stopped, walked over to the guy, looked him straight in the eye and said one of the most truthful things I’ve ever heard.

“If you’re not here to get your brain washed, you’re in the wrong place. Don’t you think you all need a little bit of brainwashing?” he asked the addict.

A few days later, the anti-brainwasher was kicked out for hooking up with one of the young women he shared his drug of choice with at the facility. It’s funny how it’s never the sex or porn addicts that hook up at these places.

In a nutshell, CBT is self-brainwashing.

The other idea this clinician introduced me to was the concept of the “pre-lapse.” His contention was that once you’re at the stage of relapse, you’re going to engage in your addiction, but if you can nip it in the bud in advance, you’ll never reach relapse stage. There are a series of almost ritualistic thoughts and behaviors most addicts, regardless of the specific addiction, go through prior to using. Once that chain of events begins, it’s hard to derail it.

I learned how to derail the pre-lapse with cognitive behavioral therapy. I used it to tackle both my alcohol and porn problems and although muscle memory has made coping with the addictions easier, I still have CBT in back pocket.

As long as I live and I see an ad for beer on television, I’m going to have the Pavlovian response of thinking it looks tasty. That’s because the first beer or two is tasty. It’s when I feel this way that I pause and remind myself that I’ve never stopped at one or two and can’t stop at one or two, so I can’t have any. That works now. When the pull was harder years ago, I’d start thinking about all of the horrible things I’d done or said when I was drunk and how I never wanted to go down that route again. Eventually, maybe the commercials won’t trigger any response.

With porn, if I see a beautiful woman on TV or in the movies, I’ll sometimes have the immediate thought, “I wonder if she’s done a nude scene.” In years past, that would lead me to one of those celebrity porn websites. Today though, I’m able to pause and ask myself, “What does it matter if she’s done a nude scene? What will I see that I’ve never seen before?” I find that when I boil porn down to its essence, naked people being objectified, I want nothing to do with it.

And whether it’s alcohol or porn, I’m able to look back at the last six years: First, my worst year of addiction, then getting in legal trouble, attending two rehabs and hundreds of hours of therapy, a six-month jail sentence, hurting so many people close to me, almost bankrupting myself all leading to what is today a very isolated, often lonely life. My choices with alcohol and porn led me here and having spent time with addicts, I know I’m actually one of the lucky ones. Reflecting back on these last six years is a quick trick to put any porn or alcohol triggers to rest.

Yes, it’s easier now going into Year 5 of recovery than it was Year 3 and certainly Year 1. For those of you who are in the early stages, don’t fret. Just stick with it. You have control over your actions, even if you need someone to teach you how. Seek out a CBT therapist and make the recovery journey a successful one.