Maintenance... "Clean" or not? What does 'clean' mean to you??

Discussion in 'Opiate & Opioid addiction' started by Jon_F, Feb 21, 2005.

  1. Jon_F

    Jon_F Newbie

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    I have been on Suboxone the last month and plan to be for as long as I can. I have been using drugs heavily the most of my adult life, about 12 yrs. I am 26 now. I really dont like going to support groups and NA meetings in such, they just seem so corny to me. My parents think I should go to therapy but I already know whats wrong with me, why I do it and all that shit and I dont think talking about will help anything. What kinda bugs me is people on maintenance say they are clean and other people thinking I am clean. Although I dont shoot up no more and pop pills like crazy I dont think I am clean because I am still on an opiate. And to beat it all, I find myself wanting to take more than prescribed and I obssesivly count them and aration them out and shit like any drug addict will do with a regular drug.I get 20 mg and it actually does me good but I have some pretty bad chronic pain and sometimes I just wanna nod out and not do anything so I may take an extra few mgs on some days. At least I can say I still have at least a half to take the day I see the doctor every two weeks to re-up. It took me a lot of presuading just to get that 20mg but If im feeling like this surely I could use some more couldnt I. Or am I still just a junky? lol Sorry to get off the subject, Anyway, I would like to hear some input from somebody about whether a maintenance patient has the right to call themselves clean. I also would like to hear from anybody who is on Sub as well and hear how they are hacking it.
     
  2. Silver Fox

    Silver Fox Silver Member

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    Hi Jon_F,

    How are you doing, are you still on the Suboxone?

    Maintenance or Clean - it is an interesting philosophical point.

    The idea of Maintenance is to give some stability; to get off the roller-coaster of drug-induced highs and withdrawal lows. Maintenance also buys you some time. Time to 'normalise' your life, Time that you don't have to spend trying to find money to fund an opiate habit, Time to move away from the using circle of 'friends'/dealers, Time to remember what you used to enjoy doing before drugs dominated the scene.

    Technically, being Clean means being off drugs. Off opiates, and going further, off any drugs.
    People on maintenance often consider themselves clean beacuse they are no longer having to feed a dependence by buying illicit drugs, however, a physical (and possibly psychological) dependence still remains! In actual fact, they are NOT clean.

    The philosophy of any maintenance program should be, ultimately, to allow individuals the option of detoxing and totally coming clean. This is usually achieved most successfully after a period of stabilisation / maintenance when people have made up their minds that they want to be clean, when they have stopped illicit drug use, and have made some lifestyle changes that will stand them in good stead for Life After Detox, ie. simply to have some solid long-term plans.

    Coming off Suboxone is quite manageable; a gradual step-down / reducing regime is easily done under the guidance of a good doctor.

    In your case, you mention 'chronic pain' - is this from an injury or previous surgery? If so, the pain issue needs to be addressed. Ask for referral to a pain specialist; sometimes there are pain clinics which also deal with the overlap between pain and opiate dependence. There may be other more appropriate ways of treating your pain, depending on the origin and nature of the pain.

    If, on the other hand, the pain is mucle or joint pain that derives from opiate withdrawal symptoms, it may be that your Suboxone dose is inadequate. The worst thing that you can do is to take more of your Suboxone on certain days, as this will simply increase your tolerance, and will make you feel even worse on the days that you have none. It is important that your pain is assessed in order to establish the cause, and to be treated appropriately. If the current dose of Suboxone is not 'holding' you, the dose may need to be increased.

    Cheers,
    Silver Fox

    I hope this is useful+
     
  3. moda00

    moda00 R.I.P. Platinum Member & Advisor R.I.P.

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    Re: Maintenance Medications.... "Clean" or not?

    Bump! This is an interesting question albeit a very old thread. Without any false claims or attacks, I'd be interested in discussing individuals' experiences and personal opinions on this matter.

    Personally I feel that a lot of what is in question here is morality. "Clean" is good and the opposite is "Dirty," which is bad. When one gets a "Dirty" urine test one has "Failed" that UA. I feel that since this mindset is a part of our society, and having drugs in one's system is considered bad, weak, morally wrong, offensive, evil, impure.. the list could go on but you get the drift.. and the words we use to describe such states reflect the underlying attitudes of our society. It is thus easy to see maintenance as continuation of the state of being "Unclean." Since drugs in general and drug addiction in particular are perceived as negative, the use of another drug in place of the drug of addiction can transfer that negative stigma; in addition, the view of drug use as weakness and recovering or quitting as an act of will or strength can render other methods, such as maintenance and taper as "lesser" options, or a sign of weakness in the individual utilizing them. I also feel that the OPs language in "do I have the right to call myself clean" reflects on this, the idea as an addict of others judging you and determining whether your choices are valid- which is inevitable to some extent, because we make some pretty harmful choices during active addiction, but in general it reflects that the idea of recovery and beating addiction is outside oneself and measurable by someone else's standards, which is not necessarily helpful.

    However, this issue can also be discussed in terms of what CLEAN means to you. Aside from the clean/dirty and inherent underlying issues with vocabulary, what does "clean" mean on a more personal or spiritual level, what are the criteria? How do you feel and how do you know when you are "clean," and/or what other terminology do you prefer to describe having overcome addiction and other struggles?? Do you differentiate between the role of maintenance in the process of recovery as being different from its potential role in the final "destination" of being "recovered" or "clean?"

    To me, if someone is doing well and has found something that works for them, that shouldn't be discouraged on a personal level. It has been shown that opioid maintenance is often associated with positive life changes in measures of health and well being, and other treatment options for other substances of abuse/addiction are being developed after this model. It is also true that maintenance is not effective or desirable for everyone. That having been said, everyone has different views on the subject and I would love to hear some differing perspectives about the underlying philosophical issues.

    Again, let's keep this thread positive- no matter your opinion, please explain it as such, and no personal attacks. And of course, while maintenance is usually discussed in the context of opiate addiction, the concept is being researched for implementation in other areas, specifically stimulant addiction at this point in time, so discussion need not be limited to opioid substances.
     
    Last edited: May 12, 2008
  4. sweetsugar

    sweetsugar Titanium Member

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    for SWIM clean means being not addicted to whatever one had been addicted to. I was addicted to Heroin but is now clean. I had areletivly small addiction to Benzo's, but now clean. SWIM steers clear of these drugs... and of most other drugs for now and the near future, although I am smoking heeps of weed... Hmmmm.. I would say she is clean :)
     
  5. RunRedFox

    RunRedFox Gold Member

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    I believe being clean, is in fact being free from the grips of dependence of a particular drug. Addiction alters your brain chemistry and I have noticed from personal experience and from observing friends that the addicted mind often fluctuates with the chemical, logic often flies out the window. Although, maintenance does allow the chemical dependence to be satiated in a way that the person does not have to compromise their morals or priorities it does still leave the body and mind dependent and does likely still have a psychological effect.

    I see chemical dependence and addiction to be intimately linked. I believe regulating ones intake is a step in the right direction much like a rationed diet but I still think taking that substance clouds the mind to a certain extent and makes it difficult to maintain a consistent frame of mind.

    I think it is important to consider the physiological standpoint. Addiction effects the brain as does chemical dependence, its not entirely that it is right or wrong per say but it does interrupt the natural state of the mind. That being said I do not believe it is in the best interest for everyone to try to beat addiction cold turkey, there is evidence that relapse is far more probable then if one tapers, but I personally believe being chemically dependent does effect your thinking.


    edit: I know, I know propaganda and the like but I do think that substance dependence does effect the brain as just about any habit does, and simply because I know inhibitory neurotransmitters cause hyper polarization in the axons in the brain making it more difficult for an action potential to be reached, which would in fact lead to less neurons firing, making less connections due to the lower occurrence of neuron activity... blah blah blah.

    for what its worth http://www.youtube.com/watch?v=hzP-4N2Qfs0 please disregard any of the unpalatable ways that they may present this information.

    All this said, I think its important not to judge a particular treatment path. If it helps someone for the better, thats all that really matters.
     
    Last edited: May 12, 2008
  6. oggy

    oggy R.I.P. Silver Member

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    Great posting moda and rx. Swim thinks that its your own free will to choose that you really want to come off drugs, then it would have to be going cold turkey is the best way to go, ISO. Why suffer the slow painful tapering over years when you can have it all over in less than a week? Plus the fact that methadone/opiates are the strongest man made pain killers, MENTALLY! How can one love when one is taking a drug that's mentally blocking emotions out? This goes for all antidepressants ISO.

    Choose life? Choose fear? Choose love? Its all up to you!
     
  7. moda00

    moda00 R.I.P. Platinum Member & Advisor R.I.P.

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    Let's keep it on topic here, this is not about the best way to get off opiates. The original question posed is whether a maintenance patient can be considered "clean" and why or why not.

    As an overview for those without immediate relation to the subject, maintenance is most commonly utilized in opioid treatment through buprenorphine and methadone and, less commonly, heroin (diacetylmorphine) prescription or morphine maintenance. It includes studies having been done on drugs including modafinil, amphetamines, and others for cocaine addiction maintenance. It can include nicotine gum or patches, or even the idea of switching from one substance to a totally different substance (ie. taking benzos regularly after coming off opiates, for example)

    Some other possible questions-
    What do you feel the current "standard" of being clean is in our society? How do you feel about that? Do you feel there should be one set definition of clean or that it should be a personal definition? How does that tie in to these issues of maintenance?

    How has your perception of "clean" changed over time, whether or not you have been through addiction? I am really interested in hearing how this has been impacted and how individuals' perceptions of recovery evolve, both those who have been through it personally and those who have not had an addiction issue.
     
    Last edited: May 12, 2008
  8. RunRedFox

    RunRedFox Gold Member

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    I believe the term clean likely originated from clean piss tests and carried over as I do not think the industry is all that creative. Is you urine clean or dirty... etc. I would extend this however as I have said to a clean mind, one that is not adulterated with chemical interference as it takes away some of the objectivity and even the subjectivity of our thought and filters it through an odd scope of implied priorities.

    As for our society, I do not think clean has much meaning to anyone outside the recovery machine. Likely people outside the know would use more derogatory terms like junkie or fiend and would apply these labels due to physical observations or blatant anomalies in character (ie. glassed over eyes, whilst taking quickly, or a stumbling stagger, or confusion and the like... etc). However I do feel drug use if detected is usually frowned upon and misunderstood, as us as people have a tendency to fear things we do not understand and have been conditioned to fear.

    I personally do not judge a person on their drug use or addictions unless I can blatantly see a maladaptive coping behavior that has evolved out of this, then I try to point this out and can often be quite dickish about it (as I believe honest is far better for a friend then fake kind words). I feel maintenance is a step towards stability, and a chance to set up a support network outside of the drug world and for that reason think it is a necessary step for many, but I do not think it should be the end of the path to recovery. Although, I do think that the sickness and withdrawal process may be beneficial as it establishes a negative association with the substance of choice in question, I know swirx will not touch morphine anymore after withdrawing bad 3 times fully, when thinking about the drug, all he can remember is retching on the floor in agony.

    A different example of maintenance, could be that nicotine gum. Anyone that has been around smokes can attest to how irritable they get when they haven't had a cigarette for awhile, getting more nicotine often becomes a priority and they can become angry for seemingly no reason. If you observe someone who chews nicotine gum the same is true, but now they have substituted the cigarettes for gum, they have avoided some of the physical harms associated with the addiction but if you take that gum away, you better believe they will get just as irritable, lash out just as hard, and run right to the store to buy some cigarettes(cigarettes are way cheaper then the gum of course...) or bum one. The person is still Dependant and their brain is still under the grips of their initial addiction, sorry to say it, but it is a great step to start a controlled taper and start breaking the association of things with the nicotine which is important for breaking any habit.

    As for the word itself and its meaning, it is always dangerous to use polarized words in treating people that need support. Placing a negative association on the word could possibly harm someones sense of self and I think altogether the word does little to convey anything solid. I think spelling out the actual level of abuse or dependence and what its actual implications are, are in fact far more beneficial for everyone. It allows for definite growth without demonizing someone for being affected by a difficult dependence...

    In short, maintenance is a step in the right direction, but by no means an end to addiction, it still has its shortcomings and if life allows should lead to a taper or quitting, or so I personally believe.

    As for my perception, it has changed a lot in recent years. When I was in treatment years back being clean didn't seem to have any merit. Drugs were not bad and they could never do me or anyone else harm or so I believed. Once I became a ciggarette smoker I didn't realize any value to being clean until I was forced to quit by an ex of mine. Only then did I begin to realize how my life was ruled by that addiction, were I went, who I hung out with, how I thought, my emotions and feeling. They all seemed intimately attached to that substance... more recently I have been observing friends in the grips of addicted thinking, their blatant fallacious thinking. It seems a lot more obvious since I've for the first time been removed from the substance what is going on... I can in retrospect see myself being guided by a chemical rather then genuine intention. If anything I think clean means free from chemical dependence, although use in moderation does not have near the negative effect.

    Edit: I just remembered a philosophical thought I had awhile back. What purpose does pain play, emotional or otherwise. Pain is the catalyst for change, without it there would be no motivation to do much of anything if there were no passion to do so. Or so I see it in my life.
     
    Last edited: May 12, 2008