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This year, most of us have experienced a tremendous amount of new psychological and social stresses. These stresses can increase the risk of low mood, anxiety, panic, fear and obsessional thoughts of contracting infection, and more.

Prolonged stress can trigger addiction or substance misuse in people who were already at high risk of it, but can also trigger a spike in substance misuse in the general population who would not normally have been at risk. Some people will “self -medicate” with alcohol or drugs to try to cope with stress.

Others who are already addicted to drugs or alcohol may struggle to get their usual supplies, due to social distancing and disruption to medical supplies. Some people will be cooped up with family or loved ones who will suddenly realise they are addicted to drugs or alcohol and throw out all their current supplies.

All of these factors have combined together to create a crisis in addiction.

How do I spot signs and symptoms of addiction?

Each person’s experience of addiction will be slightly different, but they usually share common features to be aware of.

Common signs of addiction:

• Secretiveness
• Unexplained outings, often at very short notice and with urgency
• Drug taking equipment such as unusual pipes, small weighing scales and sometimes needles and syringes
• Small packages such as in plastic, paper or foil packaging.
• Changes in social groups or circles, new or unusual friends
• Secretive phone conversations
• Lying
• Stealing

Common symptoms of addiction:

• Changes in mood such as being unusually happy, sad, or anxious
• Changes in energy such as being very tired or equally being unusually energetic or “hyper”
• Changes in weight
• Changes in sleep such as sleeping a lot more or a lot less than usual
• Looking unwell at certain times but rapidly looking better soon after, in a repeating cycle
• Pupil size can change and look different to normal
• Unexpected persistent cough without having a cold or flu

In general, if someone is addicted to something, they tend to:

• Always think about the addiction
• Change their lives to fit around the addiction; it seems to “rule their life”
• Experience difficulty controlling the addictive behaviour, even when the addiction is hurting them or their loved ones
• Need to do more and more of the addictive behaviour
• Feel withdrawal effects when they cannot engage in the addiction

Be cautious though: Both symptoms and signs can be due to other causes. Therefore, it is much more useful to look for groups of lots of these symptoms and signs rather than just one or two in isolation.

What types of addiction should I look out for?

Substance Addictions:

• Alcohol
• Cannabis
• Cocaine (or crack cocaine)
• Benzodiazepines (diazepam, lorazepam etc)
• Opioids (heroin, opioid based painkillers such as cocadamol, codeine, morphine, dihydrocodeine, methadone, buprenorphine)
• Sleeping pills
• Hallucinogens such as LSD or ecstasy

And don’t forget legal substances which can lead to addiction, including:

• Nicotine
• Caffeine

Behavioural addictions:

• Computer use (video games, online gambling)
• Console gaming
• Gambling
• Sex
• Eating

What do I do if I suspect a loved one has an addiction issue?

Family members and loved ones are more likely to be able to spot these signs since lockdowns have resulted in a huge increase in the time that people spend together at home.

If you think that someone may have a problem with addiction, it is important to seek professional advice. There are also a number of different online websites which can provide free information and support:

1. https://www.nhs.uk/live-well/healthy-body/drug-addiction-getting-help/
2. https://www.talktofrank.com/
3. https://adfam.org.uk/help-for-families/useful-organisations

How do I know which treatment option is right?

Everyone is different and people suffering from addiction have choices in how to respond to it. Some will not be ready to acknowledge there is a problem. This is a tough situation for loved ones.

Others are keen for treatment. For addictions, the main goal is to reduce harm to the person and also to all those around them, as well as to society in general.

For alcohol and non-opioid drugs, the two main approaches are abstinence or harm reduction by reducing use as much as possible if the person is not willing to stop yet. Abstinence means stopping the drugs/alcohol/behaviour completely. For opioid addictions, there are two main options:

1. Substitution therapy
2. Abstinence

Substitution Therapy

Opioid addiction causes harm to people and society. There is much evidence to support reducing this harm by replacing the opioid with an alternative prescribed opioid that is less harmful overall, such as methadone or buprenorphine. These don’t give the same highs as other illicit opioids such as heroin or fentanyl and stay in the blood stream for longer.

Choosing this route can help to reduce the use of illicit/illegal opioids and can allow the person a chance to work on psychological and medical treatment for their addiction, as well as trying to improve their social health through rebuilding family life or getting back to work. The majority of UK services provide substitution therapy for opioids. Substitution therapy can aim for abstinence in the longer term or for “maintenance” therapy where the substitute is continued long term to reduce harm. The main risk of substitution therapy is that a person stays on it long term or just misuses it to supplement their addiction.

Abstinence

The option of abstinence means a person will undergo a “detoxification” from the opioid and then embark on a programme to help them stay off the drugs. Some people are highly motivated towards abstinence rather than longer term substitution, and with the help and support of a professional team, this is another valid option in UK guidance. Some people will have particular reasons for pursuing abstinence such as being able to work in certain jobs, to drive and so on. Any option needs to be chosen by using a shared-decision making process between the specialists, the individual and their loved ones / family. This requires mutual respect and honesty if it is to be successful, and any decision must be patient-centered.

Any person wishing to become abstinent from opioids in particular must be made aware of the risks if they go back to using drugs. Once the body has come off opioids, it gradually becomes more sensitive to them again and if a person takes a previously used higher dose of opioids, there is a risk of that dose being too high and too strong. Therefore, it is particularly important for abstinence-oriented treatment to include education on the risks of overdose if a person relapses and the body’s sensitivity to opioids after a detox.

Our unique holistic approach to help you get back to life

At the BONDS™ Clinic, we operate an abstinence and supported recovery programme which helps the individual get back to life.

Shared decision-making is at the centre of our approach.

First, a holistic assessment is an essential foundation to getting the diagnosis right and helping to come up with a comprehensive treatment plan. The majority of the patients we see have a combination of addiction and a mental health disorder such as depression, anxiety, PTSD or even bipolar disorder. This is called a “Dual Diagnosis”.

The BONDS™ assessment and treatment protocols use what we call a Bio-Psycho-Social model. This means assessing three areas:

1. Biological/medical features – Including addressing any co-existing mental health disorder and relapse prevention
2. Psychological features – Including talking therapies, MDT reviews and other support throughout recovery
3. Social – Re-integration back into the patients’ social and professional world as part of recovery, rather than lengthy period of rehabilitation

When coming up with a treatment plan, we encourage the following three principles, in order of importance:

1. Safety
2. Effectiveness
3. Cost effectiveness

The results of an early version of the BONDS™ protocols were published in the year 2000 in the journal Addiction Biology and showed:

• Around 50% of opioid patients being abstinent at 12 months
• 97% of patients not reporting pain during the 1-week detox period

Patients often tell us that a fear of pain during a detox is a big barrier to seeking abstinence and we feel it is very important to discuss this.

The challenges of 2020 have resulted in significant barriers to delivering traditional residential detox and treatment programmes, due to the rules on social distancing and personal protective equipment (PPE). This has resulted in more people seeking outpatient treatment such as that offered at the BONDS™ Clinic. The BONDS™ Clinic’s newly expanded outpatient service – situated in Bradford – offers people a way to work at freeing themselves from their addiction in their own home – reducing the need to travel during the pandemic. The treatment is complemented by support from an experienced clinical team who are available on the phone and via video consultation, ensuring the individual feels supported every step of the way.

Medical Director at The BONDS Clinic, Dr Amal Beaini has worked in substance misuse for 24 years and treated more than 12,000 patients at Detox5 at Cygnet Hospital Harrogate, England, and latterly at The BONDS Clinic at The Ridge Medical Practice, Bradford. He has treated both NHS and private patients.

Together with his team, Dr Amal Beaini has submitted a written evidence based report to the Scottish Committee outlining recommendations for future practice. This has been published by the Scottish Affairs Committee and can be accessed via the link below:

Click Here

Whilst there is no doubt that there is a genuine need from prescription pain medication, there is definite cause for caution as this area of prescribing is open to misuse.

Here at The BONDS Clinic we regular work with patients who have developed a dependency on prescribed opioids and other pain medications. Many patients do have a genuine pain management issue that will need treatment and management alongside our addiction services.

Common concerns we encounter weekly centre around patients fears that their pain will become a driver for maintaining opioid misuse. A skilled and experienced team, a through assessment and a holistic approach is recommended when tackling the issue of pain management and addiction. This is a challenging area.

One of our patients very kindly agreed to share their experiences of recovery, please see the link below for the article in full:

https://www.refinery29.com/amp/en-gb/2019/07/234193/opioid-crisis-uk?utm_source=twitter&utm_medium=twitter_share&__twitter_impression=true

Viktor E. Frankl’s ‘Man’s Search for Meaning’, in all its honesty, justifies its tagline — ‘The classic tribute to hope from the Holocaust’.

Frankl along with his wife, brother and parents was captured and put in one of the Nazi ghettos in September 1942. In next three years he worked as a slave labourer in Auschwitz and Dachau concentration camps before his release in April 1945. While he majorly worked as a labourer, Frankl also provided medical support in Dachau camp, in the last days of his imprisonment. After release, he worked as a psychologist and neurologist in Austria, Vienna and USA on the theory of Logotherapy, the psychotherapy using Logos, Greek word for ‘meaning’. It is considered the ‘Third Viennese School of Psychotherapy’ after Freud’s psychoanalysis and Adler’s individual psychology. Later, he remarried and had a daughter. Frankl’s family was either gassed or died during their tenure in many camps. His sister was the only survivor of Holocaust.

The story line

Unlike many other books written on Holocaust, Man’s Search for Meaning is a narration of how the human mind responds to adversities and an ever-present threat of death. Frankl claims that once a person finds a reason to stay alive, he can get through any suffering, no matter how long drawn or how profound. Very mindfully, Frankl has kept the focus of the book to narrating psychological observations borne out of camps’ proceedings, restricting his use of details of the events in the camps to explaining or corroborating his theoretical constructs.

Just like a usual day in a camp, the book serves the readers mundane in its most unattractive form. Frankl, by means of his observations, drills down into the reader’s mind and churns up previously unfelt emotions, awakening a new dimension of vicarious suffering, both physically and emotionally. What bubbles up is an unprecedented feeling of compassion and acceptance for not only your own sufferings, but also for all fellow sufferers of the world.

The book begins with an account of how Capos, the police personnel inside the camps, were selected. His focus remains on the psychology that compels one human being to commit atrocities on others.

He then highlights the frame of mind of inmates at different points of time, starting from when they are first captured and sent to one of the camps not knowing whether they will be taken as prisoners or gassed to death. The reality, as Frankl narrates, takes some time to sink in for a camp inmate to finally understand and accept that his ‘freedom’ has been taken away. At this point, an inmate in concentration camp thinks much like a prisoner caught for a crime. Frankl describes the journey of emotions a person goes through, coming to the realisation that his life now depends on the temperament of those who hate him, and that his very existence could be wiped off at a moment’s notice.

He then describes the impact every day events have on an inmate’s thought process, making him emotionally dry and yet vulnerable. The desire to live evaporates and the person becomes emotionally dead. This affects his physical immunity, making him an easy target for physical death from disease. While most people drown in the ocean of sorrow and succumb to the utter misery of the dreary camps, a few decide to live through it gracefully by not letting their self-esteem and inner goodness take a dip. The latter category, as Frankl claimed, often finds something worthwhile to dream of in their otherwise seemingly bleak future, eventually helping them to get through.

The style

Frankl has explicated complex observations on human psychology in a lucid and storytelling fashion. Some events have been described with such precision that one can visualize them vividly. Important details have been shared in the beginning itself to prepare the reader and offer enough width for him to dive into the finer nuances of human behaviour. The narrative never becomes depressive or loses touch with what the author promises to deliver — a deeply moving account of what is it that lets a person make the choice to live when everything around him has fallen apart; and in our battle for survival, how much of a say we have.

Of all his observations, Frankl has kept his primary focus on three ideas –

– the persistent trial of a human mind to keep itself alive, — the ability to get used to the most unimaginable circumstances, and — the significance of love for a man too weary to acknowledge any emotions

For me, the most beautiful part in the book is where Frankl introduces the idea of love in his quest for survival. His love is not romantic. It is a longing — for a woman he once deeply loved — whom he might not see again, ever — for all that was good and is now gone — for all that was imprinted in his memory and no imprisonment or atrocity would ever be able to erase.

His memories are a secret and secure hide-out, keeping him warm and constantly supplying him with the zest to dream of a beautiful life. Frankl describes the beauty of his beloved’s memory as the orange hue that finds it way as the dawn cracks on to the grey gloomy sky, while he silently marches with his batch of laborers through cold dungeons on frost bitten feet. While his physical being was tormented due to his surroundings, his heart and soul was in a different world where his beloved would ask him questions and he would answer.

In an otherwise pragmatic book, Frankl brings in a beautiful heart-warming and heart wrenching description of his idea of love — claiming that love makes the suffering bearable irrespective of what you possess and what not.

Frankl outlines his thoughts with a poet’s precision. His impeccable etchings make the horror of Holocaust come alive for readers, while the author takes them on a ride to the deeper truths of his fellow companions. Frankl surfs through the ocean of human thoughts, jolting the reader’s consciousness to accept and admire the zeal of everyone who has been through the greatest of human miseries. The objectivity of his observations is admirable for he does not let his own thoughts influence readers’ subjective experience. He simply states; for this reason the reader often feels like he is a part of the plot, walking with the prisoners to the fields through cold grey dawns.

The actual story is captured in 100 pages, the last one third of which is sheer poetry. He encapsulates all that he has learnt during imprisonment into small lessons and shares them as anecdotes, ascertaining that suffering stays suffering only until we are able to find some meaning in it. Once a person pries out the hidden truth or meaning behind his suffering, he finds it in his heart to accept it; then prepare to live through it. While establishing the significance of ‘meaning’ for a human life, Frankl detaches it from the perception of greatness and claims it to be an ever-changing and ever-evolving phenomenon.

In the end, Frankl has given a brief description on Logotherapy and the work he did in this field after his release. He breaks down the concept into multiple small notes and explains them one after the other. Man’s Search for Meaning is a book that takes us through some of the most inexplicable human emotions and thoughts in a lucid journey, which at the end, leaves the reader startled and fulfilled.

Frankl decodes these thoughts layer by layer, extracting the underlying truth. Every line in this book is a deep insight into the existence of a human being, as himself or a part of society and to really construe Viktor E. Frankl’s philosophy, one would have to keep coming back to it, again and again.

About the author: Viktor Frankl was born in 1905 and was a Viennese psychiatrist and neurologist who developed the theory of logotherapy. He was a student of the University of Vienna where he studied medicine, focusing on the subjects of suicide and depression. He was taken in Nazi camps in the year 1942 along with his family. Although Frankl had an option to escape before he was caught by SS, but he decided to stay with his parents and family. Frankl stayed in Nazi ghetto, Auschwitz and Dachau concentration camps before his release in 1945. After his release he dedicated his life to propagation of Logotherapy and help people find meaning in their lives. He worked as a psychotherapist and counsellor. He has won many illustrious awards in his time. Frankl passed away on September 2, 1997.

“Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism”

There is NO point having a 1-2 week detox if there is no plan of care afterwards! That is why The BONDS™ Clinic offers a follow up program which can include naltrexone implants (after careful consultation with a doctor), as well as the all-important 1-on-1 Talking Therapies and regular follow up with our medical team. No two clients are the same and so treatment should be individualised to each person.

But is there any evidence that Naltrexone is effective? Here is a paper from the prestigious British Journal of Psychiatry which was just published online in 2018, although it first appeared in the paper journal in 2009.

Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial by Nikolaj Kun⊘e et al.

They used 6 month implants in one group of opiate dependent patients, and compared it to a group who did not receive implants but had other standard treatment. They measured opiate levels in hair as well as urine testing and self reporting. The results are as follows: Those who had naltrexone implants had 62% fewer days of opiate use. The Addiction Severity Index scores were better in the naltrexone implant group. The naltrexone implant group showed lower amounts of of polydrug use (use of several drugs) and, importantly, the implants helped reduce craving. The implant group also said they were more satisfied with their treatment. The authors conclude that naltrexone implant treatment is safe and significantly reduces opioid use in those seeking abstinence.

When the implant is nearing the end of its lifespan, we hear from our patients that “The craving is coming back, Doc”.

Our patients tell us that help with their craving is really important to many of them and we see the positive effect Naltrexone may have on cravings reported by our patients with varying types of addictions, including alcohol, opiates, cannabis, cocaine and others.

Naltrexone can form a useful part of an individualised treatment program where medically appropriate and after careful consultation and informed consent. Managing cravings can allow patients to move forward and create new daily routines, along with enabling successful engagement in dual diagnosis treatment. However, nothing is a “Magic bullet” and the best starting point is being motivated to seek treatment, whatever type that may be.

Many aspects of our lives revolve around the quality of sleep that we get at night. Energy, health, productivity, mental capacity, memory and emotional balance are all contingent on getting a good night’s sleep.

In addiction recovery, the quality of your sleep can greatly impact your ability to deal with triggers, life’s stressors and more.

How Sleep Affects Your Mental Health

Ever wake up happy and energized after a night full of restless tossing and turning?

No.

That’s because only a great night’s sleep leads to a happy and energy filled day.

Lack of good sleep causes you to be a total grump, dragging through the day with a lack of focus. That is just the start of all the problems lack of sleep can create for you physically and emotionally.The good news is when you do find that full night of restful sleep, the benefits are wonderful.

Sleep, what is it good for?

Sleep is good for absolutely everything.During sleep your brain repairs your body, physically and mentally.

It is during sleep, in the deepest stages, that tissues grow and muscles relax and energy is restored. With about 7 hours of really good sleep, your body goes into fix-it mode. Sleep restores hormones, skin cells, liver functions, heart health, and more.

It’s almost like you are a super hero with the power to regenerate, only on a much slower and realistic level. Okay, so it’s not like you are a super hero; but it is still very amazing!

Poor sleep is associated with a higher risk of mental illness that goes beyond the grumpiness you feel due to a hangover or from staying up too late binge watching your latest box set. The next day you will not only feel like a zombie star from The Walking Dead, you will look like one too.

When you don’t get a good dose of sleep, your brain begins to function differently. It does so in a bad way.

You can see it in your skin like when you have bags under your eyes because of tiredness. You can even see it in your behaviours, like how you yawn all day at work, fall asleep during the team meeting, or drink 25 cups of coffee because you need help in finding the energy to make it through the day. Lack of sleep can also be related to mental health disorders.

Mental Illness Affects Sleep

Not getting enough sleep does not necessarily lead to a mental illness. But, sleep problems are common among people suffering from depression, bipolar, anxiety, schizophrenia and attention deficit disorders.

Sleep and mood are directly related. If you get a good night’s sleep, you wake up happy. If you get too little sleep, you wake up irritable. Sleep can enhance your mood, either positively or negatively. If you have been diagnosed with depression and you do not get proper sleep, your depression could become worse. If you have schizophrenia and lack sleep, this could affect the hallucinations you experience. It is very important for you to recognize your sleep patterns and if you feel you are not sleeping properly, take the time to make changes.

Insomnia

Insomnia may be a symptom of substance abuse, mood, anxiety and psychiatric disorders. There are various types of insomnia. It’s important for you to determine if you have acute or chronic insomnia. Acute insomnia is short term while chronic insomnia last for a long time or is recurrent. There is also primary and secondary insomnia. Primary insomnia means you are having problems sleeping but those problems are not related to a health problem. Secondary insomnia is when your sleeping problems are related to a medical condition you may have such as asthma or heartburn. Insomnia can slow our emotional processing making it hard for mental health treatments to work. This means recovery can take longer for people who are lacking sleep.

For example, if you are a recovering from addiction, insomnia can make the recovery process more difficult and lead to relapse if not treated. It can also cause further damage.

The damage of Sleep Deprivation

The effects of sleep deprivation are quite noticeable.

There will be no mistaking it for something else. You will be moody, hungry, and irritable and have a hard time concentrating or staying focused on tasks. Every single thing will get on your nerves and you will find it hard to control your mood swings. Sleep deprivation can affect your work abilities also. What if you are an air traffic controller or a brain surgeon? You need to be the most alert you can be. Once you figure out how to get good sleep, you will be able to easily implement such techniques into your life and quickly feel the effects of good sleep.

How to Get Good Sleep

There are many strategies you can use to ensure you get a good night’s sleep.

Make sure you do not have a lot of distractions like the television or radio playing. Keep a structured routine. This will help your body get used to when it is supposed to wake up and fall asleep. Exercising during the day can help you rest better at night but should be done at least three hours before you go to bed. If for some reason you still can’t fall asleep, engage in a relaxing activity such as a warm bath or reading.

Other strategies for good sleep include avoiding alcohol and caffeine. Also, don’t take naps late in the day and make sure you have a good sleep environment. If you are not having any luck solving your sleep problems after trying several of these techniques, it would be a good idea to meet with a health professional to help you figure out what is really wrong with your sleep patterns.

Sleep is extremely important. Making sleep a priority in your life will lead to positive outcomes. So, put yourself first and get some good rest!

Addiction and Sleep Disorders Are Often Co-occurring and Debilitating

Believe it or not, sleep issues and substance abuse have always gone hand in hand. Sleep disorders are five to 10 times more prevalent for individuals who have an addiction. Alcohol and opioid use have been known to cause sleep disturbances such as disrupted sleep and difficulty staying asleep. While sleep medications are generally safe for people, they can be a hazard for substance users. Contraindications can lead to injury or death. Sleeping pills can, like most other drugs, also be misused or become addictive.

How Sleep Gives the Addicted Brain a Chance to Heal

Bad sleep can set recovery back. It’s so important to maintain your sleep, in order to stay focused upon your own recovery.

Sleep reduces stress levels, helps you make better choices and gives you the energy you require to keep yourself healthy.

Recovery is all about healing the mind, the body and emotional well-being.

When we sleep, the body goes to work healing wounds and protecting our body from illness. Good sleep is a huge immune booster. Becoming sober is also hard work, and in order to problem solve well and focus, your body needs a good amount of sleep.

The Reality of Dealing with Insomnia While in Recovery

Insomnia is common while people are experiencing withdrawal or are in recovery. Drugs can greatly alter the body’s hormone balances and metabolism which directly affects sleep. Insomnia can manifest itself in restless sleep, difficulty falling asleep, waking up too early, etc.

When dealing with insomnia, take time to create a good bedtime routine. Maybe start with a cup of herbal tea and a bath followed by cozy pajamas and a book.

Do things that help you feel drowsy, but don’t get into bed until you are ready to sleep. Finally, the last and most important thing to do is limit distractions caused by electronic devices.

If it helps, keep a diary of your sleeping habits and strategies that do and don’t work. This will help you identify the best ways to help you get to sleep and stay asleep.

Some Healthy Sleep Habits When You’re Recovering from Addiction

Healthy sleep habits are like any skill: they must be learned and practiced.

When in recovery, it’s important to have a routine in your day that supports your sobriety, and that routine needs to include healthy sleep habits.

We suggest these following tips:

Stick to a sleep schedule, even on weekends.

Practice a relaxing bedtime ritual.

Exercise daily.

Evaluate your bedroom to ensure ideal temperature, sound and light.

Sleep on a comfortable mattress and pillows.

Beware of hidden sleep stealers, like alcohol and caffeine.

Turn off electronics before bed.

In summary…

The importance of sleep has been proven time and again; it improves our memory and our ability to learn, it regulates the body’s metabolism, and it can also aid the recovery process.

Within holistic addiction treatment, emphasis is placed upon the implementation of regular sleeping patterns during recovery and your health and well-being as a whole!

We are a sponsor and are very proud to be involved in women’s football.

It’s important for children to be given the chance to play sports.

It can give the child a support network of friends as well as filling their time productively.

The women’s team are great role models for young girls.

They play and train at a high standard and young girls can aspire to play in the top leagues as well as represent their country.

This thinking is common place in many places; social media, work, television and relationships for example.

It is a form of negative thinking.

We are passing control of our lives to another.

Giving away responsibility for our lives and rendering ourselves helpless.

Working in therapy with the negative thinker is common place. It’s a habit based upon the truth as the client perceives it. They have become conditioned to the thought that their happiness is not in their own hands. It is here that we work with this perception. This involves challenging the clients ‘set in stone thinking’.

What happens if you work on you and your happiness?

What happens if you don’t visit the past or the future and work here in the now.

What does that look like?

Happiness can be a foundation to build on. Not dependent upon you achieving a goal in the future. We don’t have to remain unhappy until we find a job or meet that boyfriend. These behaviours, while increasing your own happiness, also open you up to greater success in life. It’s easy to imagine how a positive outlook can rub off on those around you attracting new people and opportunities.

So it’s not “I will be happy if”.

Training your thoughts to become positive ones will alter the chemicals in the brain and this will benefit your mental health. You will find more happiness in your life and attract positive interactions thus taking back control of your own happiness.

It will be “I am happy”. Now you can build on that foundation. You have started to change your thinking. This will need to be managed on a daily basis. Knowing what you need to avoid and what makes you happy.

I really love it when a client gets me thinking, and later after our session I went away to reflect on my clients thoughts. Here are my personal thoughts on the amount of control we have over our destiny and what we do to change that amount.

As a child brought up in Manchester in the 1970’s, Blackpool was a place that I visited regularly. The flashing lights and the noises along the piers would beckon me in to the arcades. Older kids would play the games and I would watch. I loved the pin ball machines. The art work, the sounds, and lights infatuated me.

Now imagine you’re a child – as I was – and the pin ball was new to you. You had never seen a pin ball machine before. The first time you had ever clapped eyes upon it the table had been stripped of its lights, art work, and noises. You are seeing it as a very large bagatelle game – but it operates automatically. It appears that the only control you have over the game is a spring-loaded plunger and two flippers, yet you play it, you find that the movements are random and not in your control.

Now as I did as a child you watch a zen pinball wizard for the first time. They appear to have complete control, moving the ball with what appears to be perfect precision, racking up the points at an alarming rate. So, what extra control does the pinball wizard have that you don’t? Purely mechanically, there are three mechanisms involved; precise control of the plunger speed – this controls where the ball goes first; perfect timing of the flipper use – so the ball goes off at the right angle, which would sometimes involve just letting the ball bounce off the flipper rather than being flipped, or trapping the ball at rest with the flipper; and ‘nudges’ – where the table is nudged gently to slightly deflect the ball at the moment it hits an obstacle and changes direction, you must nudge gently or the table registers a ’tilt’ and penalises you.

You have seen it with your own eyes, you know what to do. But when you start to play with this additional information your will find that it has not improved your game. You have all the technical information needed to achieve a large measure of control of the ball, just like the experts. So what do you lack? Practice, yes, but practice to do what?

I would watch the experts in the arcades when I was younger – there is concentration, and more. They seem to be at one with the table, controlling the ball with their whole bodies, indeed as part of their bodies, an extra limb, aiming a ball at a target is now no more calculated than controlling your leg muscles to walk.

You may be confused and wondering where does ‘zen’ come in? We live in a world which appears to determine our lives, zen and humanistic theories give the possibility of achieving liberation from the internal and external chains that would restrict us. Zen paradoxically says this can be achieved by realising that we are not separate from the rest of the universe; it’s the ego which says “press the left flipper button, now nudge the table diagonally up…” – it impoverishes both our pinball and our lives. Technically, most people have more than enough information to control their lives, it is only as they learn to realise their oneness with that they discover that the small choices they make at each moment can come together into a pattern of life of their own choosing.

We can fall into traps along the way. The illusion of powerlessness we take from the smallness or our own choices – looking at the pinball table for the first time – the illusion that the answer lies in gaining large amounts of knowledge – learning about plunger, flippers, and nudges – taking enlightenment as a goal in life rather than a recovery of something always available to us – getting absorbed in pinball. We need to be aware that, for all our skill, the ball will eventually go out of play, and the game will end. If I am desperate to avoid this, I will never push the plunger, I will stop the ball on the flippers, playing ‘safe’ to avoid the end of the game. The life will have gone out of my pinball, and I will fail to achieve anything on the scoreboard. In accepting the game, and knowing that it will end some time, I can play my game at my highest level of skill, and then, when the time comes, withdraw and leave the table to others

Pinball is not unique: there are many recognised zen arts – martial arts, dance, painting, gardening, yoga, walking in the country side, etc. Give one a try and you may discover an extra dimension to your life or a different way to cope, a different way to reconnect and discover what you already had. At The BONDS Clinic, we understand that our clients are individuals, therefore, we do not offer ‘one size fits all’ therapy. We work with people at their own pace, and encourage reading, reflection, and growth.

Just like the client that got me thinking, clients can explore and understand more about their lives when given the time and environment to do so. The day that you plant the seed is not the day that you eat the fruit. Recovery is a journey of discovery.

After some deliberation, I decided to see what all the fuss was about and went for it. I gave it my all – I read a load of books, downloaded numerous apps, watched videos online, listened to podcasts and guided meditations, etc. As I said, I really did jump into it. If you haven’t tried mindfulness, I do recommend that you give it a try. It really is fascinating and eye-opening to see how beneficial mindfulness is and how the variety of different techniques and methods out there can be applied to individual situations.

One of the main concepts that I repeatedly came across was ‘acceptance’.

The practice of acceptance means making a conscious and continuous effort to accept everything that happens in life for what it is. Even the disappointing, crushing, heart-breaking things. These bad things can sometimes be hard to deal with and really difficult to get over, but what I began to realise was that I started to cause myself more pain and heartache by dwelling on them and pretending they hadn’t happened or weren’t real – in other words, not accepting it.

I’d often find myself thinking things along the lines of ‘this shouldn’t be like this’ or ‘I wish this wasn’t happening’ and I’d spend large amounts of energy wishing the bad things away rather than just accepting that it’s already happened and dealing with reality of it.

The idea of acceptance itself is counter-intuitive to people as our natural reaction to negative things is to push them away, yet I’ve started to see that acceptance isn’t about disregarding the trauma that has happened, it is about acknowledging it and coming to terms with event. If we internally fight against the event by wishing it didn’t exist, we make it much worse for ourselves. Acceptance is a hard concept to articulate and understand but is very much worthwhile.

Although acceptance can be difficult, but I highly recommend you try and adopt the concept into your life. It could make a subtle yet powerful difference to your days.

Some of the most common myths and confusions about drug detox include:

“I Have to Hit Bottom Before I Detox”
While many people do wait until their world has fallen apart to come and get treatment, there is no reason to let things go so far before seeking help. Any problem which is addressed early is more likely to reduce any collateral damage. Early intervention and access to treatment has a proven track record for resulting in recovery and sustained abstinence. The overlying goal is to experience a higher quality of life, and getting help sooner, rather than later, can mean that less repair work is called for.

“Everyone Will Know About My Problem If Have a Detox”
Our modern detox programs are designed to be discrete, fit in to your life and most of all are safe and effective. We offer an outpatient model which varies in therapeutic input to allow for discretion also. Chances are that those closest to you are already aware that you are struggling with addiction. Even if this is not the case, neither social circles nor employers need be privy to your choice to access treatment. Your right to privacy, confidentiality and discretion must remain a high priority.

“Detox Medications Are Just More Drugs”
Medications can assist in the transition toward being drug-free, if deemed appropriate after careful consultation with a health care professional. Unlike cases of self-medication, medically supervised detox treatment should ensure that only the correct doses are administered, and at the correct times, unlike “self medication”. A medically supervised detox will also use medication that is produced by trusted companies where you know that is has not been cut with “fillers” or anything else. We believe the aim should be for short term use of these medication, and we aim towards the clear goal of abstinence.

“Religious Beliefs Are Required”
While many addiction treatment programs are known to provide clients with a structure which includes specific belief systems, the following of any particular religion is not a necessary aspect of recovery. The most important faith for recovery is the hope and belief that things can get better.

“Detox Hurts”
Most of us have watched films where the ‘drug addict’ character holes up in a room, sweating and moaning for days as the drugs leave his system. While this may be a likely scenario for those who choose to go it alone, modern detox treatments are designed to make the process as tolerable as possible. Specific medications can be used for reducing the side effects of withdrawal, but these should be relative to the type and severity of the abused substance and decided upon after careful consultation with a healthcare professional. Care should be taken to ensure that participants are as comfortable as possible, both physically and psychologically.

“Detox Is the Goal”
Some believe that just getting the substance out of the system is the key to recovery. In reality, this is “stage one” on the road what may be a long journey. The factors which contribute to an individual’s tendency toward drug misuse do not disappear once the chemicals are expelled from the body. Work-related stress, family issues, and feelings of hopelessness may even seem to increase, once an individual is facing life head-on without the “numbing effect” of drugs or alcohol. A successful treatment program will tend to these mental and emotional needs both
during, and following, your treatment.

“Relapse is The End / is a Catastrophe”
The process of overcoming addiction is not always a straight path up the mountain. The descent into addiction is sometimes referred to as a “downward spiral,” and the path back upward can be similarly winding. Even with the correct support and treatment pathway, some may be tempted and relapse may occur. While it bears to keep in mind that substance use following detox can be dangerous or even fatal, it does not have to mean that the steps already taken toward recovery are worthless. Previous successes can be added to future successes, even if the previous successes were short-term.

“I Can Do It By Myself”
Some people have become abstinent without any input, but sadly many of us can’t and require support. Full blown addiction is a medical illness and is often not something we can just get over by “pulling ourselves together”. None of us exist in a social bubble. While independence is encouraged, we rarely end up accomplishing goals in complete isolation from the world. Because our own thinking is so often involved in continuing certain behaviours to sustain the addiction, it can be difficult to convince ourselves that a life without substances is possible. For every story of someone who ‘beat’ addiction on their own, there are many more who have benefited from seeking assistance along the journey. Ultimately, we must acknowledge the risks associated with detox, which can be high and in some cases even fatal if done without the correct medical supervision and intervention.

Naltrexone was synthesised in the 1960s and was initially used in maternity services. In the event of opiate based analgesic given to the mother during labour and the newly suffering from sedation and difficulty in resuscitation. Naltrexone was clinically used in the 1970s. It’s therapeutic potential was limited by poor drug adherence hence the need of a ‘responsible adult’ to supervise the daily oral 50mg naltrexone tablet or 2 tablets (100mg) Mondays and Wednesdays and 3 tablets (150 mg) on Fridays.

The first studies on long acting monthly depot injections occurred in the 80s culminating in the SHERMAN injection and VIVITROL injection. The latter was initially licensed in the USA for alcohol addiction and later on for opiate addiction as well.

The first implants for clinical use were made around 1995 by WEDGEWOOD Pharmacy. They consisted of a cigarette sized pellet of compressed naltrexone powder. At one time they also included slow release TRIAMCINLONE to reduce tissue reactions. The advantage of these implants was their effectiveness and complete disappearance within 6 – 8 weeks.

A later implant was manufactured in the USA by Dr George SHERMAN and is a one gram Naltrexone pellet with 10 gram of slow release triamcinolone providing effective opioid blockage for 10 -12 weeks.

In my current capacity as medical director of The BONDS™ Clinic and previously in my capacity as clinical lead/consultant at detox 5 (1995-2015) I pioneered the use of what I called ‘Double Sherman’ using two 1 gram pellets instead of one. In my experience, this provided a more definitive opioid blockade for 12 weeks and occasionally 13/14 weeks was reported by my patients. This was also monitored through rigorous yearly audits.

A similar one gram Naltrexone implant is now licensed in Russia (PRODETOXON) and was researched in St. Petersburg in Russia in conjunction with the university of Pennsylvania, Florida, USA. However, no implants are formally licensed anywhere else in the world at present and can only be used on a “named patient basis” in the UK (naltrexone injections are licensed in the USA but not yet in Europe). The so called 2nd generation implants (Australian) Dr George O’Neil implants used another well established technique inserting naltrexone in a 10 pellets matrix providing 1.8 grams of naltrexone and opioid blockade for up to 6 months and another 2 matrix implant (3.6 mg) providing naltrexone blockade for up to 9-12 months in a small number of cases according to the manufacturer, but we feel it is more realistic goal is 6 months of action. We must all remember that every person is different and metabolism of medication can vary significantly between people. We do not believe that anyone should be “guaranteeing” a length of efficacy of implants, as we have observed some to do in the past.

The FDA in America has fast tracked licensing studies for the O’Neil implant there but any American licensing decision will depend on the outcome of those studies. We await those results with interest over the coming years.

The pre-implant assessment is very important and necessary to rule out or identify any co-existing medical, chronic pain conditions and/or mental health disorders. An implant is only one of a range of options that our team considers and only after consultation and assessment and only if appropriate. Clients sometimes get frustrated that “other clinics have just put me an implant”. We cannot change our adherence to these high standards and make no apology for them: safety must come first and this means discussing all options with your healthcare provider.

These assessments can also pick up co-existing mental health disorders and it is so important to treat these too, as well as the addiction. This is the expertise offered by the The BONDS™ Clinic dual diagnosis service. We are not talking here only about mental health “problems” but well defined mental health disorders eg depressive disorders, bipolar disorders, suicidality etc…
There are also clear Contraindications to the use of Naltrexone of any type:

1. patients on opioid analgesics
2. patients with current opioid dependence
3. patient in acute opioid withdrawal
4. patients who fail the Naltrexone challenge
5. patients who show positive opioid urine and or saliva tests

Overall, please remember that a solid foundation for success in medicine is a careful holistic assessment and treatment plan made in collaboration with your healthcare professional after considering all the options available to you.