Persons with mental health or addiction issues often deal with stigma. In turn, stigma negatively affects mental health. This downward spiral makes it harder to seek treatment, leaving people feeling even more socially isolated.
Stigma consists of a label used to exclude an individual, causing them to internalize this label as part of their identity. They generally consist of labels based on negative stereotypes about a specific demographic. For example, the word “junkey” can be stigmatizing for persons with an addiction. So how does this affect someone’s mental health?
Stigma affects mental health by inflicting further harm on already vulnerable populations. A person may internalize a stigmatizing label, causing further isolation, distrust, and low self-esteem, resulting in increased anxiety or depression.
Anxiety is the fight or flight response to stigma, whereas depression is the purposelessness and hopelessness resulting from this downward spiral.
In this article, I share the experience of Stephanie, a fellow recovery advocate who experienced a great deal of stigma during active use and recovery.
How Stigma Triggers Anxiety
Persons already suffering from mental health or addiction issues often experience anxiety. A stigmatizing social environment amplifies this anxiety. As Stephanie states:
“When I got off the drugs my anxiety went right through the roof. It told me I was a mess and no good and that it would be years before I ever was trusted or treated “normal”. When people stigmatized me, it confirmed those anxious thoughts for me. A lot of my recovery work has been on my anxiety. It was bad before I used, but after it was worse.”
While in a vulnerable state of recovery, she had to navigate family, friends, and professionals who treated her differently due to her addiction. She states:
“It’s not so much what they said as how they treated me. They were cold and avoided conversations with me. There were a lot of snide comments about how I should make better choices… everybody wanted to make sure I understood how much I hurt the people around me… they didn’t seem to think I knew.”
This sense of being different from everyone else leaves a person feeling isolated. Without a sense of social support, persons who are already vulnerable experience increased anxiety, particularly in social situations. As Stephanie states:
Social situations could mean answering a lot of questions based on stigmatic things people heard and believed about addiction. It could mean people talking horribly about me because of the life I previously led. It could mean running into people from my past that could tell others around me that didn’t know… because of the stigma and negative perceptions, I had horrible anxiety when having to go into social situations. Until I was strong enough to use an education “shield” to deflect the anger towards the stigma and educate the person using the stigma, I would avoid all social settings at all costs.
As the isolation and anxiety spiral further, it makes it increasingly difficult for a person to pull themselves out of this difficult place.
How Stigma Affects Identity
As stigma takes over one’s identity, a person begins to internalize stigmatizing labels. This process can also be called “self-stigma”. The labels become anxious thoughts, replaying like a broken record. Stephanie’s mind raced with self-stigmatizing thoughts:
“You are a fuck up… You cant do this… You are not good enough… No one likes you… You can’t work… You’re stupid… You won’t get better… You will never stop… No one will take you seriously… Everyone is better off without you…”
This self-stigma is further reinforced when interacting with others who make off-handed remarks regarding any of these anxious thoughts. Stephanie felt like she was living in a constant state of judgment:
“It made it worse and harder to navigate the world. I was afraid that everyone would hate me. I was always second-guessing everything I did and how people perceived me.”
This prevented her from being able to reach out for help. Living in this state of anxiety led her to believe there was no way out:
“I was hopeless and believed that I would not be able to get help. In my own head, I was a lost cause.”
What Stigma and Anxiety Have in Common
Stigma and anxiety are both based on fear. We fear the unknown, and a person using stigmatizing language often does not know or understand the experiences of those they stigmatize.
Beyond the realm of mental health and addiction, we can find a great deal of stigma in the politics of immigration. Before the pandemic captured all of the headlines, immigration was one of the biggest global issues. This included issues like Brexit, Trump’s statements regarding Mexicans and other minority groups, and the surge in nationalism.
Stigma does not often come from true hatred. Even when hatred does exist, the issue goes much deeper. Beyond hate, anger, and frustration, you can often find fear. Immigrants and other minority groups can provoke fear among those who lack familiarity with such groups.
When we feel threatened by economic uncertainty, fear often gets projected outward as anger. Immigrants and other minority groups often become scapegoats for this fear.
Now, more than ever, we need to keep our fear in check. As we navigate a world full of heightened fear of contagion, we need to consider the humanity of others, rather than resorting to broad stigmatizing labels.
Stigma affects the mental health of persons who are already vulnerable by further instilling a sense of social isolation. This social isolation increases social anxiety, potentially leading to internalized self-stigma. Self-stigma makes recovery increasingly challenging as it becomes reinforced by others, leading to further marginalization and a sense of hopelessness.
Recovering from stigma requires separating yourself from the negatively spiraling self-reinforcing thought loops. Rather than identifying with a self-stigmatizing thought, greet it like an old friend, welcome it in, and tell it you have more important things to focus on right now. Then focus on those more important things, letting it be.
Recognize persons who perpetuate stigma are often doing so based on fear or ignorance. Their reactions to you say more about them than about you.
Lastly, stigma makes it difficult to trust others enough to reach out for support. This is a large part of what kept Stephanie stuck in her addiction. When she gained the courage to reach out for help, she broke the power of stigma, finding a supportive treatment facility. Through the support of staff at Aegis Health Group in Windsor, Ontario, she was able to rebuild trust, coping skills, and the confidence to succeed in her recovery.
Unfortunately, many people do not encounter supportive professionals the first time they reach out. Like so many others, Stephanie had to reach out to various sources before finding the right fit for her. If you have been unable to find the right support, persistence will likely pay off when you find the right fit. I discuss this topic further in my article here.
If you would like to learn more about Stephanie’s story of recovery from addiction, you can find it in my article here. If you want to reach out to her, you can contact her on her personal Facebook page here.
When someone with an addiction is in denial, their mind creates a system of rationalizations, justifying their harmful behaviors. The human mind has an extraordinary ability to come up with reasons to make us feel better about our behavior.
“I’m not that bad… I’m not hurting anyone else… It’s Friday… I deserve it.”
Many different types of denial keep someone stuck in addiction. A common feature that drives many types of denial is a psychological phenomenon called the self-serving bias. It is our tendency to attribute positive outcomes to ourselves and negative outcomes to external events outside our control.
For a gambling addiction, this often consists of the thought that you win because you are skilled, but you lose because of bad luck.
This type of denial is different than lying because the person believes their own reasons. It is like lying to yourself and believing it. This type of self-deceptive denial comes in various forms among persons with addiction. Some of the most common types of denial consist of the following:
Each of these are types of cognitive distortions, logical fallacies, or defense mechanisms that keep a person trapped in a state of denial regarding the nature of their addiction.
I composed this list by compiling over one hundred responses by persons with addiction or their family members who shared their experiences justifying an addiction. I thematically analyzed each response, classifying them into eight sections.
Let’s take a closer look at each of these types of denial and how they serve as rationalizations that maintain an addiction.
Minimization consists of psychologically diminishing the severity of an issue. These types of denial consist of the following statements:
I drink less than others whose lives aren’t a mess, so it’s not like I have a problem.
I’m not as bad as other people.
Well, at least I’m not like THAT.
I’m not an alcoholic.
I still have a job and lots of friends.
I’ve never been violent or abusive, and I’ve never gotten into trouble with the law.
It’s not a big deal.
I don’t use it every day.
It’s only a couple nights a week.
I can go for one more, why the hell not? I have the money, time, and privacy.
It’s free/ cheap, so no real effects.
I still take care of myself, so I’m not really having problems.
I’ll do this amount, but not all of it. No one can tell.
This is my one vice. I’ll just do it occasionally, so I don’t get addicted.
Jesus turned water into wine… so drinking can’t be such a bad thing.
What’s the difference were all gonna die eventually?
I’ve never really wanted a long life anyway, so if it kills me, it kills me. I’d rather die young having had lots of fun than live a long boring life.
Gambling-specific forms of minimization consist of the following:
I only have $200 left, so I might as well go.
I received some back pay, so I justified it as money I was not expecting.
It’s only $50.
I don’t drink or do drugs, so this is a healthier addiction.
Optimism bias consists of an unrealistic belief that things will work out, and one will not experience negative consequences. This type of denial may include the following statements:
Even though I couldn’t function today and get anything done, I’m SURE tomorrow will be different.
I’ll just go to the bar and not drink.
I’ll only have one drink.
I’ll only have a few drinks… no drugs.
I’ll only have a bit of cocaine, nothing else.
I will just gamble until my next win when I get back all I’ve lost.
This machine is about to pay out huge.
If I win big, it would solve all my financial problems and could help my family.
I have paid rent, and I have been living on one meal a day for years, so I will be able to get through it.
This bias is particularly relevant in gambling addiction since the random intermittent reward structure reinforces the motivation to continue through the hope of a future payout.
Avoidance coping consists of avoiding distressful thoughts or emotions rather than effectively dealing with them. Addictive substance or behaviors serve as a way to avoid these thoughts or emotions in the short-term, causing further long-term distress.
Using a substance to self-medicate in this way can feel like the drug is keeping you alive, helping you function every day, but one must consider whether or not this is a short-term gain at a long term cost.
Using substances or addictive behaviors to avoidantly cope is like continuing to walk on a broken leg, taking painkillers instead of dealing with the issue.
This is a particularly sensitive area that needs to be approached with empathy and compassion since simply moralizing this form of self-medication is not helpful. These areas can be carefully explored further in a collaborative therapeutic relationship.
Many persons report using substances to cope with depression, anxiety, or anger, while in reality, realizing they just didn’t want to feel their emotions. Common statements include:
I drink to quiet my mind.
I’m more relaxed.
It makes me better socially.
All my friends only like me when I’m half in the bag and having fun.
I have a high level of stress in my life.
This consists of using a substance to avoid the pain and intrusive thoughts associated with trauma. Again, it is important not to moralize these reasons, dismissing them as mere excuses. Effective treatment can address one’s relationship to these thoughts. Statements might include the following:
I have PTSD from bad parenting.
I was abused as a child.
It was here for me when no one else was.
I am unable to handle this tragic loss.
Avoiding physical pain
This consists of using a substance to ineffectively cope with physical pain and should not be conflated with using a substance to effectively cope with physical pain. Substances can be used either way, and the key is knowing the difference. Consulting a medical specialist in your specific area of chronic pain might help determine the difference.
Another way substances are used to cope with physical symptoms in the short-term is to avoid withdrawal. This is particularly relevant for alcohol or opioids since the withdrawal can be physically debilitating for a significant period. Many individuals justify continued use due to the inconvenience of going through the withdrawal symptoms. Statements might include the following:
I’m letting myself drink because it is better than the shaking.
I don’t have time to get sick from the withdrawal.
I won’t be able to function and take care of my family.
Avoiding the short-term dysfunction of withdrawal often results in longer-term consequences.
Avoiding boredom is a common justification for an addiction. Working in problem gambling prevention, this is one of the more common reasons I hear. Statements often include the following:
There’s nothing else to do.
This is the only thing going on in this city.
There’s not a lot of places to go for people my age.
These rationalizations seem entirely true, but upon further exploration, there are usually several other possible outlets for entertainment.
These are a form of cognitive distortion that makes someone overestimate or underestimate the level of control they have over a situation. When overestimating the level of control, it may also be considered an optimism bias. When underestimating the level of control, it can lead to hopelessness and an unwillingness to accept what one can control.
Phrases that highlight an overestimation of control include the following:
I can stop whenever I want.
I can do it on my own.
If I really thought I had a problem, I could quit.
I’ve gotÂ this under control.
Phrases that highlight an underestimation of control include the following:
The point of no return has been reached.
It’s a disease, so I’m powerless to do anything about it.
My father was an addict, my grandfather was an addict, so it is genetic.
It’s not my fault… my parents made me this way.
Anyone else in my situation/ circumstances would probably be doing the same or worse, so I can’t be blamed.
Mental filtering is aÂ cognitive distortion that occurs when someone selectively focuses on certain positive or negative aspects of an event, magnifying certain elements and minimizing others. It is one of the major factors that maintain denial by reinforcing an optimism bias.
For example, a person may focus on specific ways a substance makes them function better while neglecting the harmful effects. Common statements include the following:
It helps me stay focused and get things done.
I can’t think straight without it.
I’m not as smart without it.
I still go to work.
I can still maintain all of my responsibilities.
I take care of my responsibilities (i.e., raise the children, pay the bills, etc.) I am entitled to a little discretionary fun.
It only affects me.
I’m not hurting anyone but myself.
In the case of gambling addiction, this can maintain a state of financial denial when someone focuses on the wins and forgets about the losses. One can also justify the increasing expenses by focusing on how the bills are paid while neglecting to focus on savings.
Normalizing is another way of maintaining an optimism bias, diminishing a sense of personal responsibility, and selectively focusing on the entertainment value rather than the harms. Common statements may include the following:
Everyone’s doing it.
Who doesn’t drink!?
If alcohol was really bad, it would be illegal.
It’s a special event.
I’m over 18.
It’s a social thing.
This is a cognitive distortion where someone believes good things happen to good people, and bad people are ultimately punished. This belief can sometimes manifest as self-victimization when one blames oneself for a situation, accepting their suboptimal lifestyle as a form of punishment. Statements might include the following:
It’s my fault.
I deserve this terrible lifestyle.
I’m not good enough for anyone anyway, so I might as well.
I deserve the pain I have.
This consists of not taking responsibility and blaming others instead. It also commonly manifests as a form of projection whereby one criticizes others for things that resemble their own faults. Statements might include the following:
If you were to spend more time with me, I wouldn’t have to run to the bar/ casino.
If you had done a better job with my dinner or ironing my clothes or keeping the house clean, I wouldn’t need to do the substance/ gamble.
You took me there. It’s your fault I gamble.
I gamble because of all the pressure you put on me, and I want to give you more because I never feel like I’m good enough.
This list contains some of the most common types of denial, keeping someone stuck in addiction through rationalizations that justify their behavior. If the above statements resemble your own thoughts, it might be helpful to consider their accuracy.
This article also does not imply that every person with an addiction is in denial. Persons with addiction are in various stages of contemplating change and might be fully aware of the harmful impact of their actions.
Also, I do not intend to imply every person who uses substances has an addiction. There are many ways to use psychoactive substances effectively that do not result in harmful long-term consequences. If you are interested in learning more, check out my article When Does Something Become an Addiction?
Lastly, this article is not an exhaustive list of the various types of denial, so feel free to leave a comment if you have one that has not appeared here and I will add it in.
Working as an addiction counselor, I’ve come to recognize some common early warning signs of a relapse. A large part of recovery is maintaining momentum toward healthy positive habits while effectively coping with difficult thoughts or painful emotions. Since relapses begin long before they happen, it is important to be able to spot the signs in one’s thoughts, emotions, and actions.
Catching a relapse early allows one to pivot back toward recovery before getting caught up in the downward spiral. Since relapse prevention is such an important area of recovery, I decided to compile a list of common early warning signs.
I created this list by collecting responses from 75 individuals in recovery and professionals in the addiction field. I then clustered the responses into a list of 12 themes. I wanted to capture a wide variety of experiences since everyone’s recovery looks different, and not everyone will share the same warning signs.
Here is the list of early warning signs of a relapse:
Becoming irritable and reactive
Becoming dishonest and deceptive
Worrying about other people
Overconfidence in one’s recovery
Shifting back into unhelpful networks
Feeling increasingly apathetic
Increasing boredom and entertainment seeking
Falling out of healthy habits
Increasing suicidal thoughts
Getting stuck in your head
Avoiding positive and negative feelings
According to a 2015 study on relapse prevention, these are common symptoms associated with post-acute withdrawal syndrome (PAWS), which may last up to two years.
Unlike acute withdrawal, which I wrote about here, PAWS consists of the longer-term emotional and psychological effects of discontinuing an addictive substance or behavior. A person may initially have no symptoms for weeks, falling into post-acute withdrawal unexpectedly, causing a high relapse risk.
I compiled this list of warning signs as a comprehensive yet brief resource one can quickly scan as a reminder of common red flags to watch out for. Catching yourself when you fall into the “stinking thinking” will hopefully allow you to reduce the risk of relapse.
Let’s take a closer look at the meaning of each early warning sign on the list.
Isolation is one of the most commonly cited relapse risk factors. Isolation can cause addiction, and addiction leads to further isolation.
The loneliness made me have time to think and the more time I had to think the more I wanted to use because all my thoughts were about using or the horrible person I had become while using.
In recovery, isolation further instills the sense of being separate and disconnected from others. Human beings are social creatures, and isolation cuts us off from this basic need. Increasingly isolating oneself heightens the risk of relapse and can be an early warning sign.
Becoming Irritable, Reactive, and Resentful
Becoming increasingly irritable is another commonly cited warning sign of a potential relapse. Irritability generally consists of being highly reactive to situations. Instead of being able to take a step back when a problem arises, reacting consists of impulsively lashing out based on the emotion.
This reactivity carries over to one’s relationships were resentment builds leading to interpersonal conflict. Every small thing becomes perceived as a personal attack, and one begins to take on a defensive posture in one’s relationships.
As irritability, reactivity, and resentment build, one’s mind becomes rigid, and one’s sense of separateness from others is further instilled. As one progresses down this path, the risk of turning to addictive substances or behaviors increases.
Shifting Back Into Unhelpful Networks
One of the most frequently cited pieces of recovery advice is the need to change one’s network. Staying around the same unhelpful people leads to the same unhelpful behaviors. You are the product of the people you spend most of your time with.
I dropped a lot of friends that still used. My best friend used cocaine, and I had to distance from her, too. No one ever wants to be alone, but the first bit of recovery is just that. It’s about tearing down the social network and rebuilding it with people that aren’t involved in that life.
A huge warning sign for a potential relapse is the withdrawal from social support, meetings, and reverting back to spending time with old friends who reinforce old behaviors.
Becoming Dishonest and Deceptive
Dishonesty and deception are some of the most common features of addiction. When in recovery, one is encouraged to begin telling the truth and speaking with candor.
While experiencing an addiction, persons develop habitual patterns of dishonesty, often being able to hide their addictions from those closest to them. This dishonesty becomes a normal way of life.
Beyond lying to others and lying to oneself, deception, and conning to get what one wants further separates an individual from others as they interact through persona masks.
Falling back into these deceptive patterns of behavior can be a red flag for a potential relapse.
Getting Stuck in Your Head
When living in one’s head, attention is taken away from the present moment. Anxiety about the past and future take over, and panic attacks may overcome one’s mind with thoughts of “what if?” making catastrophic scenarios seem imminent and real.
Anxiety can be a normal part of one’s life and is not a warning sign of relapse on its own. The way one responds to anxiety is the warning sign. For more on how to respond through helpful coping strategies, see my article on How to Stop Living in Your Head.
It is unhelpful when responding to anxiety with further overthinking, catastrophizing, and fusion with thoughts that take one away from the present moment. An early warning sign of relapse is stopping effective coping skills.
It is important to distinguish a healthy concern for others and an unhealthy need to focus on other people. An unhealthy focus on others is based on an attempt to build one’s own sense of self by pointing out the faults in others. This can also result in blaming others for your own shortcomings and frequently thinking about how you have been wronged.
Another way this unhealthy focus on others can manifest is an attempt to save another person. Rather than focusing on one’s own recovery, constantly diverting one’s attention to another person allows an individual to not have to look at their own flaws. This attempt to fix or control another person comes from a place of low self-esteem.
This warning sign is tricky because helping behaviors outwardly appear generous and selfless. This kind of helping behavior, on the other hand, is based on a strong ego attachment and needing external validation to feel satisfied.
When in recovery, it is essential to consider whether or not your helping behaviors come from a healthy place. The twelfth step’s call to help others is a healthy version of helping. Paying attention to the way one is helping is important so that the addiction does not merely become transferred to this behavior. See my article “Can You Be Addicted to a Person?” for more on this topic.
Overconfidence in One’s Recovery
This is another deceptive warning sign since a high level of confidence does not seem like a risk factor. When someone says, “I got this” with passion and vigor, our natural inclination is to believe them.
In early recovery, overconfidence in one’s ability to control an addictive substance or behavior may serve as a rationalization for not having to engage in certain recovery activities. A healthy level of fear is actually helpful since it decreases the chance of testing oneself, leading to further rationalizations such as, “I deserve one drink.”
In later recovery, this overconfidence can also lead to relapse through rationalizations like, “why can’t I just be like normal people?” and the decision to try reverting to social drinking, when this has never worked in the past.
Overconfidence can also lead to the decision to stop healthy recovery behaviors and focusing on other areas of life, such as one’s career, instead. This diverted attention away from recovery, combined with the lack of a healthy fear of the substance, can increase the risk of relapse.
Falling Out of Healthy Habits
In early recovery, one begins incorporating several healthy habits. Each healthy habit is like a protective barrier, reducing one’s risk of relapse. This is why treatment programs include routines like meditation, exercise, journaling, peer-support meetings, and regular sleep.
Each of these habitual behaviors facilitates an upward spiral of recovery, building momentum over time. Overconfidence in one’s recovery or a temporary state of apathy can derail healthy habits, increasing the risk of relapse.
Early warning signs include putting off meetings, stopping prayers or meditation, a decrease in exercise, poor sleep patterns, and a general lack of structure in one’s life.
Feeling Increasingly Apathetic
Throughout recovery, there may be moments when one loses a sense of one’s values. If things are not going the way one expects and frustration takes over, it can be tempting to fall into the “screw it” mindset where nothing seems to matter.
Ironically, when nothing seems to matter, everything seems to matter. Every little road bump feels like a mountain. Apathy is a state of reactive meaninglessness, killing motivation to continue healthy recovery behaviors.
Having a sense of direction promotes mental resilience when facing difficult situations by allowing a person to reorient oneself toward one’s values. Having a mental relapse consisting of a state of apathy is an early warning sign, requiring one to pivot back toward one’s values.
Along with apathy comes boredom. When there’s no broader sense of purpose, entertainment seeking becomes central in one’s life.
In another article, I argue a sense of purpose is one of the most neglected aspects of recovery. Addiction is a problem characterized by an existential void. In recovery, if one does not have a guiding principle of underlying values or a sense of purpose, it is easy to slip into thoughts like “Why get up? Why leave the house? Why do anything?”
Like Victor Frankl said: “suffering without meaning is despair.” Chronic entertainment seeking becomes a way to escape the pain of despair, similar to the way addictive substances or behaviors function in active addiction.
Finding oneself in this state of complacency may be an early warning sign that entertainment is acting as a replacement for the addiction, increasing the risk of relapse.
Increasing Suicidal Thoughts
Suicidal thoughts are rooted in the painful despair of meaningless suffering, where one is plagued by thoughts of others being better without them. This state of hopelessness is all-consuming but temporary in the long-run.
A significant warning sign of relapse is this fusion with thoughts that others are better off without you, combined with a sense of profound disconnection from others. Using substances can be compared to a temporary version of suicide.
Both suicide and substances are a way to escape the intense pain of disconnection, burdensomeness, and hopelessness. Catching these types of thoughts and using effective coping strategies is crucial in preventing a relapse.
Avoiding Positive and Negative Feelings
As previously stated, an addictive substance or behavior, like suicide, is a way to escape the intense pain of despair. Recovery requires confronting difficult thoughts and painful emotions rather than reinforcing their power through avoidance. Avoiding these thoughts and emotions prevent further recovery since avoiding negativity also means avoiding positivity. As Brené Brown states:
“We cannot selectively numb emotions, when we numb the painful emotions, we also numb the positive emotions.”
Avoidance can result in self-sabotaging behaviors, preventing one from experiencing joy and progress in recovery. Examples of this might include withdrawing from a romantic relationship when things are going well or ruining one’s chance at a promotion when things are going well at work.
Finding oneself engaging in self-sabotaging behaviors to avoid positive situations might be a sign of unresolved underlying issues. Avoiding both positive and negative emotions may be an early warning sign of a potential relapse.
Each of these early warning signs are things to look out for while in recovery. By recognizing the signs, one can pivot back toward recovery, preventing a potential relapse.
In a study on relapse prevention, the author provides five simple rules to consider: 1) change your life; 2) be completely honest; 3) ask for help; 4) practice self-care; and 5) don’t bend the rules.
Another helpful tip to consider is HALT:
H – Hungry
A – Angry
T – Tired
If you are beginning to feel irritable and reactive, see if you can address any of these foundational areas.
Recovery looks different for each individual and some of these early warning signs of relapse might not be relevant. It is important to consider your own unique warning signs, creating a plan for how you will respond when you notice them.
Building a relapse prevention plan based on your own red flags can be assisted by the support of a peer in recovery, such as a sponsor. It may also be helpful to consider seeking the support of a professional in the field, such as an addiction counselor or a psychologist.
Hopefully, this list of relapse warning signs is a helpful resource you can use to build your own list of signs to look out for in your own thoughts, emotions, and actions.
Feel free to add a comment down below if you have any further suggestions that don’t appear on this list.
When I worked in a withdrawal facility, opioid withdrawal always stood out as the most intensely painful. At it’s worst, it looked like a demon was trying to escape from the person’s body, making them writhe and scream as their body was battered by waves of agony.
As a chemical-dependency counselor in a non-medical withdrawal facility, my hands were tied during the worst moments when no form of support seemed adequate. Between the waves of pain, there were moments of connection and clarity, but this was often short-lived.
Prescription Ibuprofen was the protocol pain medication, which might as well have been a placebo. Unless the individual specifically sought out a methadone or suboxone prescription before attending detox, they were effectively going to face the full force of cold-turkey opioid withdrawals.
After seeing a system that didn’t seem to be adequately integrated with medically-assisted treatment services, I wanted to highlight the depth of pain caused by opioid withdrawals and the need for readily available medically assisted treatment for those who become dependent on opioids.
Why are opioid withdrawals so painful?
Opioid withdrawals are so painful because of the rebound effect. Since opioids reduce one’s ability to feel pain, stopping an opioid once dependent causes the opposite effect, producing severe pain.Â
The rebound effect is a phenomenon that can be applied to many different medications. Like an elastic band, taking a substance stretches the band, pulling your body out of its normal way of functioning. Over time, your body adapts to the substance, becoming dependent on it for normal functioning.
Once you stop using the substance, like the elastic band analogy, your body is slingshot to the opposite end of the spectrum. In the case of opioids, this means feeling extreme pain. Over time, your body begins to adapt to normal functioning (homeostasis) without the substance.
Withdrawal is the time between the rebound effect and homeostasis.
Opioids block pain by attaching to opioid receptors, preventing pain messages from being transmitted throughout the body. Our body naturally produces endorphins that serve this purpose, particularly following strenuous exercise. This is why people often refer to “runners high” as a pleasurable experience.
Opioids go far beyond the body’s natural ability to reduce pain, downregulating the body’s need to produce natural endogenous opioids, like the endorphins produced after exercise.
Since the body’s natural ability to regulate pain is diminished when dependent on opioids, it requires time to regain its natural functions after stopping the substance. During this period of adjustment, the individual experiences the physical and emotional pain of withdrawal.
To help share the in-depth subjective experience of opioid withdrawal, I am going to share the experience of Stephanie, a fellow recovery advocate.
Here, I will share her experience of withdrawal from various opioids, including Hydromorphs, Dilaudid, Morphine, and Oxycodone.
The experience of opioid withdrawal
While in active addiction, the longest I ever went without using, was 3 days when my ex had gone to jail.
It starts as anxiety… a sick feeling in the pit of your stomach… you know you can’t get a fix and you’re out of options. Then you figure that there is no way out, so you’re just gonna do it.
Then the stomach problems start, along with this weird muscle thing, making it hard to move. All of your muscles tense up, and you feel like they are all locked up when walking or trying to move.
The stomach cramping and the puking are next along with sweating, and the feeling that the marrow of your bones wants to come out.
It literally felt like the insides of my bones were trying to get outside. It felt like the bones in my legs and back were breaking, over and over again.
Everything bursts like you have been beaten with a baseball bat, and your mind is going off the chain, trying to think of ways to make this go away.
You cry and lose hope, thinking, “this is it… I’m going to die.” There is no sleep. You can’t get comfortable, and you can’t shut your mind off.
The anxiety is a sinking feeling, like “oh no….what am I going to do.” And then calling everyone in your phone you think might have a line on something. It’s the feeling of defeat every time those calls yield nothing.
It’s the sheer panic that you know you’re going to be sick, and it is going to be bad. Then comes the self-loathing for ever having started these stupid things in the first place. It’s starting another round of calls to follow up with people who won’t get back to you.
It feels like someone is taking glass to your insides one minute and twisting it the next. I think the pain was what made me puke. Curled up in a ball because laying straight is just too painful. There are times you are either face down in the toilet or sitting on the toilet.
Despite all the physical pain, the mental part of this trumps all of it. Your brain is screaming at you to “GET MORE DRUGS!!!!!!!!!!!!” over and over.
It’s a whole mode that takes over, and desperation sets in.
Everything is worse at night. You want to sleep but can’t sleep. You might get an hour here or there, but either your body is in so much pain, or your mind is racing.
You’re sweating profusely and probably changing clothes a few times, but it doesn’t matter because the bed is soaked and you will be soaked again soon.
This is why people beg, borrow, and steal to get their fix, especially if they have been through this before.
When I decided to seek recovery, I sought out an addiction doctor and started using Suboxone to help with the withdrawals.
It was basically a very muted version of withdrawal.
The first 4 days, I felt yucky, but nothing major. I was mostly just having trouble sleeping. On day 5, I got knocked down. My stomach hurt, and I was in the bathroom a lot. I couldn’t focus on anything, and I was nauseous. That lasted about 5 days, then I started to feel better.
During the worst parts of it, I wanted to crawl out of my skin. That’s the only way I can describe the feeling. I took ibuprofen and clonidine, and that helped with the restless legs and the body pain. Being on Suboxone It was a much easier experience.
It really was better. And I was better prepared for it. I knew what could happen, I had supports in place, and I took a week off work. It went a heck of a lot smoother than I thought it would.
I was terrified to jump off Suboxone. It was terrifying until I got passed it. It passed, and I was still waiting for the worst of it, but it never came.
During the worst of it, there was pain, but not nearly as bad. I was really sore for two weeks, and it felt like I was walking in cement boots up to my knee.
Sleep wasn’t too bad. I would wake up a lot but could fall back asleep.
There was also a lot of emotional instability. I had no reason to cry. I thought I cried from fear and panic, but when I was coming off Suboxone, I had nothing to cry about. Life was good. My bills were paid, I had money in the bank, and had groceries in the fridge.
People do it cold turkey, and I give them so much respect. That’s hard to do, and I couldn’t have done it. Using Suboxone made it more tolerable for me. Everyone’s experience is different. This is speaking from mine.
I feel very lucky. Programs vary from place to place, so others may have to stop after tapering down to a specific dose, such as 2mg or 5mg. My program went down to 0.5mg. I jumped off at the lowest dose, whereas some people don’t have the option.
If I ever get injured, you would have to put a gun to my head before I would ever take them again… I won’t do it.
Amidst the recent opioid crisis, I hope this article sheds light on the power of these drugs to cause dependence. More than any other drug, opioids can lock a person into long-term physical dependence, due to the pain inflicted when trying to stop. Using these drugs then become a way to simply feel normal.
When adjusting to life without opioids, the rebound effect causes over-activity among the pain receptors, inflicting the torturous experience described by Stephanie. Although opioid withdrawal is unimaginably difficult, medically assisted treatment is one way to make it more manageable.
As an addiction counselor specializing in behavioral addiction, I’ve often been asked what behaviors can be an addiction. Many people are familiar with gambling and gaming addictions, but some less-known forms of addiction don’t necessarily include substances.
Addictive behaviors operate similar to addictive substances, causing craving, loss of control, and continued use despite negative consequences. Addictions are ways of coping with difficult underlying thoughts or feelings in the short-term, causing long-term consequences in one’s life.
The other behavioral addictions listed here are commonly discussed by researchers, but there is no general consensus on their diagnostic constructs.
The following sections consist of common questions regarding various subtypes of these addictive behaviors. Despite their differences, each must fit with the criteria listed above to be considered an addiction.
Relationship addiction can be classified as a form of codependency whereby an individual continually seeks the external validation of a romantic partner, generally stemming from low-self esteem and an anxious attachment style.
Relationship addiction may also often be referred to as love addiction, as mentioned above. I have written more about relationship addiction in my article, “Can You Be Addicted to a Person?“
Is chronic cheating an addiction?
Chronic cheating can be considered a form of relationship addiction. Persons continually cheating seek the thrill of pursuing new partners in addition to the external validation of new love interests. Research also correlates this behavior with narcissistic personalities.
Recent research suggests love can be an addiction, particularly “harmful forms of love or love-related behaviors” negatively impacting a person’s well-being. Love addiction can also be considered a form of codependency.
It is important to note that the neurochemistry of romantic love is similar to that of an addiction. Although similar neuropathways are triggered, it can only be classified as a form of addiction if the person loses control over their desire to seek external validation and is unable to leave the relationship despite adverse consequences.
Sexting can be considered a form of sex addiction, particularly when it begins to have negative consequences in other areas of your life, and the individual starts to lose control over their ability to regulate this activity.
Sexting consists of engaging with persons over text message using sexually explicit message content or imagery. According to research, sexting has become a normalized and widely accepted practice in Western countries.
Like any kind of sexual engagement, it can be practiced in a non-addictive way. Like sex addiction, sexting can become an issue for an individual when it begins to preoccupy their attention, resulting in an ongoing craving that has an increasingly negative impact on their life.
Can spending money be an addiction?
Spending money can be an addiction when the individual loses control of their ability to regulate their shopping behaviors, resulting in negative consequences in their life. Research has also referred to this as shopping addiction or compulsive buying disorder.
A study found the following characteristics are associated with a shopping addiction:
(a) not engage in credit management, (b) believe that their purchases will transform their lives and selves, and (c) make purchases for an emotional lift…
Although many people can sometimes identify with these characteristics, spending money can only be classified as a form of addiction when taken to an extent where it is causing significant harm in someone’s life.
Can you be addicted to your phone?
Preoccupation with your phone as a form of escape, at the expense of other areas in your life, can be a form of internet addiction. Like other forms of addiction, this results in loss of control and significant harm in one’s life.
Many people say they are addicted to their phones, but very few are actually suffering from an addiction. In that article, I share a quiz you can take to determine your level of addiction, based on the clinically validated Internet Addiction Test (IAT).
Can you be addicted to social media?
Social media can be a form of internet addiction whereby an individual engages in frequent social comparison, losing control over their use, and damaging their ability to maintain a healthy self-concept.
Likes on social media are addictive because they affect your brain, similar to taking chemical substances. Likes symbolize a gain in reputation, causing you to constantly compare yourself to your peers.
Can gaming be an addiction?
Gaming is recognized as an addiction in the DSM-5, under the classification, Internet Gaming Disorder. The preoccupation with gaming must cause significant harm to one’s life, including health, education, work, or in-person relationships.
Video games are addictive because they help meet our basic psychological need for a sense of freedom, purpose/progress, and social connection.
These needs become artificially met, resulting in harm to one’s life offline, when gaming becomes an addiction. Like an addiction to your phone, it is essential not to apply the word “addiction” too broadly.
Can you have an addiction to eating?
Compulsive overeating can be considered a food addiction. Like other forms of addiction, eating becomes an addiction when one uses food as a form of emotional escape, developing tolerance and requiring increasing amounts over time.
Unlike alcohol, drugs, or any other addictive behaviors like gambling, one cannot simply abstain from eating. Like sex addiction and relationship addiction, one must consider the quality of their relationship to eating.
Has this become an excessive form of short-term self-soothing, resulting in serious long-term consequences in one’s life? Is food being used to avoid painful emotions? Are you using food to fill a bottomless void, losing control over your portions?
These are some questions one might consider since occasional overeating does not typically fit within this category.
Can Netflix be addictive?
Netflix can be a form of television addiction. The concept of television addiction was developed by researchers in the 1970s. Although there is currently no agreed-upon definition, Netflix binging may be an addiction if it causes significant harm in one’s life.
A 2017 study acknowledged that TV series watching can be addictive, but more research needs to be done in this area to generate a theoretical rationale.
Given my background in gambling and gaming addiction, I would compare television addiction to these areas, asking comparable questions:
Is this a form of leisure activity that you generally have control over? Or is this beyond a form of leisure, acting as a coping behavior? Is it having a significant long term-cost to other areas of your life?
Can you be addicted to reading?
Reading addiction has not been officially recognized as a form of addiction. However, one may have an addictive relationship to reading if they are using books as a way to escape from difficult thoughts or painful emotions, similar to other forms of behavioral addiction.
Some forms of reading addiction may resemble work addiction, especially if one is reading to learn new material. Like work addiction, this form of reading comes from the thought that one is not enough, and the excessive desire for new knowledge is driven by low self-esteem.
Throughout my graduate studies, I sometimes bordered on this type of addiction, feeling like I needed to continually devour new material to keep up with the high standards of producing original research in a field.
Excessive reading, like working, can be productive, depending on your ability to control it and maintain balance in your life. It is only considered a form of addictive behavior if it results in significant harm to your health or relationships.
In addition to meditation, mindfulness-based therapies can help with overthinking. In my article, How to Stop Living in Your Head, I share the principles of Acceptance and Commitment Therapy (ACT), a mindfulness-based psychotherapy that has been supported by overÂ 330 clinical trials.
Can fitness be addictive?
Preoccupation with fitness can be considered a form of exercise addiction. This occurs when someone is unable to control their desire to engage in excessive exercise, despite harmful consequences to their health, relationships, and self-concept.
Research has found similarities between exercise addiction and eating disorders, particularly in the realm of self-evaluation issues. This may consist of problems related to body dysmorphia.
Beyond self-evaluation issues, exercise addiction can offer a form of escape from difficult thoughts and painful emotions, providing a false sense of control.
Like work addiction, this activity may appear productive on the surface, but when it manifests as an addiction, the behavior becomes counterproductive, leading to significant harm in one’s life.
Can you be addicted to work?
Although there is no agreed-upon definition, work addiction consists of a dysfunctional preoccupation with one’s work, causing harm to one’s health or interpersonal relationships.
Preliminary research in the area of work addiction highlights how the concept has been downplayed in the professional literature.
A 2018 study highlights myths surrounding work addiction, challenging the idea that some types of work addiction are positive. The authors state:
If an activity is defined as an addiction, the long-term consequences of excessive work will always outweigh any short-term benefits.
It is important to consider the quality of one’s relationship to work, not the amount of time spent working. The study goes on to state:
While the time spent engaging in an activity (particularly an excessive activity) is correlated with those addicted, time in and of itself is not a core component of addiction. Content and context of the behavior are far more important in determining addictive behavior than time.
A person engaging in work addiction often approaches work similar to codependency. Work may be used as a way to seek external validation to cope with low-self esteem.
As noted in the introduction, gambling disorder is the only officially recognized behavioral addiction listed in the DSM-5. Although the behavioral addictions listed here are not recognized by the DSM-5, they are recognized by several researchers in the mental health and addiction field.
Preliminary research has been conducted in many of these areas, and perhaps one day, there will be further consensus regarding their definitions.
This overview of behavioral addictions is not meant to pathologize everyday behavior. Instead, it is intended to recognize when these behaviors become destructive forces in someone’s life.
Being addicted to a person is not generally what comes to mind when people think about addiction. We generally think about addiction as being hooked on substances that have addictive chemical properties.
As an addiction counselor specializing in behavioral addictions, I’ve seen many people develop addictions to things that are not substances. A few common behavioral addictions include gambling, gaming, social media, and work. This leads to the question: can you be addicted to a person?
You can be addicted to a person. This is also referred to as relationship addiction, love addiction, or codependency. Each of these consists of seeking external validation to compensate for low self-esteem.
Let’s take a closer look at this often overlooked form of behavioral addiction.
What it Means to be Addicted to Someone
Although the word “addiction” is commonly used to describe intense craving, the clinical use of the term only applies if something is becoming destructive. As stated in my article, When Does Something Become an Addiction?
Something becomes an addiction if it begins to have significant harmful impacts on other areas of your life. In addition, the individual experiences craving, loss of control over the substance or behavior, and is unable to stop despite these harms.
Although strong healthy relationships often involve a high level of desire for the other person, the word “addiction” would only apply if this desire becomes destructive.
For example, codependent relationships often consist of one person focused on helping another person at the expense of meeting their own needs.
A common codependent scenario may consist of a spouse of a person with an addiction who feels the need to continually hold everything together. They take care of the household, make excuses for the other person’s irresponsible behavior while neglecting their own needs, and losing a sense of their own identity.
An association was demonstrated between codependency and parental alcoholism, or history of childhood abuse, or both.
These early childhood experiences may increase a person’s likelihood of developing codependent relationships. Early turmoil can instill a deep sense of distrust and relational insecurity.
Psychologists refer to this relational style as anxious attachment. Inconsistent displays of affection in childhood may result in a child being generally anxious, fearing potential abandonment. In adulthood, this results in distrusting others while simultaneously craving intimacy.
The lack of secure attachment can result in persons being highly dependent on relationships, often concerned about abandonment from a romantic partner. Rather than getting to the root of the issue, persons with this type of relational addiction seek short-term reassurance at the expense of long-term relational health and security.
Some of these short-term behaviors include the following:
Trying to impress others to get their approval
Trying to fix others
Doing things to be perceived as “the hero”
Constantly adapting to “fit in”
Like an addiction to substances, these short-term coping behaviors result in long-term consequences. Let’s take a closer look at how this type of addiction is similar to other addictions.
Addiction to a Person is Like Other Addictions
New relationships often share many features of addiction, including craving, euphoria, and withdrawal. In a study titled, Intense, Passionate, Romantic Love, the authors ask if love is a natural addiction. Using fMRI brain scans, they found the following:
…feelings of intense romantic love engage regions of the brain’s “reward system,” specifically dopamine-rich regions, including the ventral tegmental area, also activated during drug and/or behavioral addiction. Thus, because the experience of romantic love shares reward pathways with a range of substance and behavioral addictions, it may influence the drug and/or behavioral addiction response.
Since romantic love induces similar brain activity to other addictions, this leads to the question of when the clinical use of the word “addiction” is appropriate.
It would not be accurate to define every person entering into a new relationship as “addicted” since the word only applies when a substance or behavior has an increasingly negative impact on your life.
In a study on The Lived Experience of Codependency, the researchers share the experience of a person who compared the sense of obligation to stay in a dysfunctional relationship to a sense of military duty:
I would be in relationships that were unhealthy, unequal, umm unpleasant umm and I would stay in them, you know, no matter what, like a marine, umm … It’s my duty, God gave me this!
Another participant describes their sense of an unstable identity as the following:
…it is like the chameleon, you know, trying to fit in with every situation rather than allowing myself to be who I am…
The question of “who I am” is often unanswered among persons in this situation, but it is an important area to consider when trying to regain control.
Recovering from an Addiction to a Person
If you are struggling with this type of addiction, it can be helpful to reach out to a psychologist or counselor who specializes in this area.
If you are struggling with codependency, you can find local support on the Psychology Today therapist search engine.
If you are interested in trying online counseling, visit BetterHelp.com. Their main benefit is lower costs and high accessibility through their mobile app.
If you want a free trial, complete their online application here, then select the option stating you are unable to afford counseling, before entering your payment information.
A key area to consider when recovering from codependency is asking yourself this simple question: “What do I want?”
Getting clear on your values allows you to regain your own sense of purpose, building a sense of independent identity. I’ve written about values in my article on How to Stop Living in Your Head, where I share an exercise used in Acceptance and Commitment Therapy (ACT):
Imagine you have a mind-reading machine that can tell you the thoughts of someone close to you. Tune in to what that person is thinking about you. What are they thinking about what you stand for? What do they think are your personal strengths? What do you mean to this person? In an ideal world where you are the person you want to be, what do you hear this person thinking?
What theme do you see?
Come up with a few core values and keep them with you throughout the next week, being mindful of how they inform your actions.
Some examples of values include compassion, creativity, authenticity, community, order, justice, courage, curiosity, and loyalty.
If you find yourself drawn to valuing compassion, it is important to also consider whether or not your attempts to help others are genuinely compassionate.
Compassion can be defined as a form of giving for the benefit of the other person. Codependent “helping” is often not compassionate since it is intended to benefit the helper through external validation, often enabling the other person to continue down a destructive path, allowing for a perpetual cycle of “helping.”
My article, “When Does Helping Become Enabling?” takes a deep dive into the dynamics of helping vs. enabling, allowing you to better understand how to truly express compassion when trying to help someone.