#Substance Use Disorders

[macgyvermedical]

Reference Guide to Writing Drug Withdrawal

So your character has a substance use disorder (or physical dependence to a substance for another reason). This post will tell you how to write a scene (or story) in which they go through withdrawal.

NOTE: THIS POST DOES NOT INTEND TO COVER ANYTHING EXCEPT WITHDRAWAL, WHICH IS A VERY SMALL PART OF SUBSTANCE USE DISORDER AND PHYSICAL DEPENDENCE.

Substance Use Disorders and Physical Dependence:

Substance use disorders are chronic illnesses in which a person continues to use a substance (commonly nicotine, alcohol, cocaine, opioids like heroin or fentanyl, benzodiazepines, etc...) even when acquiring or using the substance can be dangerous or cause significant problems in their life (such as problems with money, safety, law enforcement, job security, child services involvement, or physical problems like wounds, infections, side effects, hangovers, and withdrawal). Substance use disorders are a common cause of physical dependence.

Physical dependence is also it's own problem and can occur for other reasons too. For example, many people take prescription medications that they would go through withdrawal from if stopped abruptly (say, because the pharmacy couldn't fill it in time and they ran out). Assuming that the medication is being taken as prescribed, physical dependence in itself does not mean someone has a substance use disorder.

So what is withdrawal? Withdrawal (sometimes called "detox") is the process by which a body stops being physically dependent on a substance. Generally speaking, it is unpleasant. This is because when a body is exposed to a substance repeatedly, it changes how it functions to accommodate that substance. When the substance is removed, there is a period of time where the body has to re-adjust to not having the substance.

For example, alcohol is very similar to the neurotransmitter (brain chemical) GABA. If you drink a lot of alcohol (more than about 4 drinks per day) for longer than about a month, the body decreases the amount of GABA it makes naturally to accommodate the "fake" GABA from the alcohol. If the alcohol is suddenly removed, the body doesn't have enough GABA, and the effects of not having enough GABA result in withdrawal symptoms.

The difference being, someone taking a medication they no longer want to take can slowly reduce the dose to minimize withdrawal symptoms. Someone with a substance use disorder usually finds cutting back nearly impossible. Because of this, managing physical dependence in someone with substance use disorder generally means giving them a similar substance which they get from a pharmacy and take continuously (methadone, buprenorphine), or a similar substance they can then taper off of in a controlled way (benzodiazepines, gabapentin).

Specific Withdrawal Syndromes:

Alcohol/Benzodiazepines:

These are the only two substances that result in a potentially life-threatening withdrawal syndrome, and it's essentially the same syndrome. As stated above, when taken for either 2 weeks for benzodiazepines or 4 weeks for alcohol, the body decreases the amount of GABA it produces naturally. GABA is the "brake pedal" in the brain, slowing things down and decreasing the amount of activity. If you don't have enough GABA, you get too much activity, which can result in severe anxiety, insomnia, seizures, hallucinations, high blood pressure, temperature, and pulse rate, heart arrhythmias, and confusion.

6-12 hours after a person's last drink, they will experience insomnia, anxiety, tremors, and headache.

12-24 hours after a person's last drink, if untreated with benzodiazepines or gabapentin, they may start to experience hallucinations (they typically know they are hallucinating at this point).

24-48 hours after a person's last drink, if untreated, they may start to experience seizures.

48-72 hours after a person's last drink, if untreated, they may start to experience a severe symptom known as delerium tremens. This is a state where they are hallucinating severely and they don't know they are hallucinating anymore. This is also a state where the person has heart rhythm problems that could result in death. This is the most dangerous period during withdrawal.

If a person makes it through 72 hours, they are usually in the clear as far as life threatening symptoms go, though they may experience mild symptoms like headaches and insomnia for long periods afterwards.

Note that medication for alcohol or benzodiazepine withdrawal like other benzodiazepines, phenobarbital, and gabapentin are given only for the first 5 days of withdrawal, tapering to lower doses each day. This gets the person through the dangerous part hopefully with no life threatening symptoms. It does not mean all symptoms are controlled, but they are hopefully kept on the milder end while the brain learns to make it's own GABA again.

Opioids:

Opioids include a range of drugs including prescription medications like oxycodone, hydromorphone, and morphine, as well as street drugs like heroin. Today, the street drug supply in many places is heavily adulterated. Many samples of heroin (and even "pressed pills" made to look like prescription opioids) contain the much stronger opioid fentanyl (which increases risk of overdose) and the sedative xylazine (which causes wounds) in addition to the expected heroin or oxycodone.

Opioids work by pretending to be endorphins- another neurotransmitter usually used by the body to reduce pain and stress. Similarly to GABA in alcohol use, the body reacts to having sustained high amounts of fake endorphins by decreasing the amount of endorphins it makes itself. This means, when the opioids are no longer present, the body can't make itself feel good or recover from pain.

There are many parts of the body that endorphins work in, including the brain, gut, nerves, and spine. When they are removed, symptoms include:

Nausea and vomiting.

Diarrhea.

Insomnia.

Anxiety.

Increased body temperature.

Racing heart.

Muscle and bone pain.

Sweating.

Chills.

High blood pressure.

There is not really a universal timeline for these symptoms like there is with alcohol. For someone who primarily uses short-acting opioids, withdrawal begins 8-24 hours after the last use (though anxiety and cravings can start much sooner). For people who primarily use long-acting opioids, withdrawal can take up to 36 hours to begin following the last use. Generally, symptoms peak within 1-3 days after they start, and acute symptoms last 10-14 days.

Unfortunately, someone who has an opioid use disorder will frequently experience cravings for very long periods of time (potentially the rest of their life) after they stop use. For this reason, people do significantly better at reducing or stopping use over the long haul if they are taking an opioid replacement drug like methadone or buprenorphine.

Methadone and buprenorphine are prescription medications that a person goes somewhere each day to get (methadone) or picks up each day from the pharmacy (buprenorphine). The drugs essentially make it so the person won't go into withdrawal and will have significantly fewer cravings for as long as they take the drug.

The management of opioid withdrawal is usually done by switching the person from a street drug to one of these opioid replacement drugs. However, it is important to note that methadone doesn't work immediately (usually it takes about 2-5 days of titrating it up to get it to a high enough dose to work, longer if the person has a very high tolerance). Buprenorphine requires a certain amount of time in withdrawal (usually a day or two) before it can be given, or it can make withdrawal worse instead of better (something called precipitated withdrawal).

Once someone is on one of these medications, they can choose to stay on them (recommended) or taper off (nice to be off meds in theory, but high rates of return-to-use).

Cocaine/Amphetamines:

Instead of pretending to be a neurotransmitter, stimulants like cocaine and amphetamines prevent the body from re-absorbing the neurotransmitter dopamine, leading to a whole bunch of it hanging out in the brain. This increases concentration and energy and boosts mood. However, taken over long periods of time, the brain kind of burns out and fails to respond to the high levels of dopamine.

You may have heard that amphetamines and cocaine don't have withdrawal states. That would be a myth. People who use stimulants repeatedly for long periods frequently have a withdrawal that is essentially the opposite of the effects of stimulants- they feel very tired, have trouble focusing, and feel depressed because their brains can't use dopamine the same way they did before the drug use. This may last for weeks after cessation of stimulants.

Unfortunately, unlike with alcohol and opioids, there's not a ton that can be done for this withdrawal. There have been several studies, including testing medications like the antidepressant mertazapine, the migraine medicine topiramate, as well as naltrexone and buproprion (also an antidepressant).

In Conclusion:

There is so much more to drug use, substance use disorder, and physical dependence than I am covering in this post. I am just covering a small part of physical dependence, however the cause, by discussing the effects and common treatments for withdrawal.

Thank you all for reading this far! I hope you learned something and will use it in your writing!

[cripplecharacters]

TW for drug usage + medical ableism

While I was looking through the disability tags I saw a couple of posts talking about people being denied their medications over assumptions that they’ll use it for recreational purposes. Idk how common this is because I’m not currently on any meds but there were multiple posts with a lot of notes so I presume it’s not rare.

So here’s my problem: one of my characters has a history of substance abuse during their backstory (the addiction is at their lowest point), and a bit before the actual beginning of the story they start the path to recovery. Part of this recovery is of course getting sober, but part of it is also getting support for dealing with their disabilities (idk if it matters but they’re a mix of physical and psychological) and some of that help comes in the form of getting medicated. Because these are both pretty big things for the character so get mentioned a lot, and because they happen in like the same segment of the story, I’m worried that it may give the impression that the character is taking the medication to use recreationally to readers, which isn’t a stereotype I want to employ at all. Do you guys think this could be a problem?

Hello,

Keep in mind that if he has a history of substance abuse disorder, his doctors are going to know that and probably will not put him on a Schedule 2 medications. Depending on where he is in his recovery, they might play it safe and avoid Schedule 3, too, or at least Schedule 3 medications that are related to what he was previously addicted to. Schedule 4 and Schedule 5 should be safe. So I would recommend finding lower-schedule medications for the conditions he has and learning about those. They won't be as powerful as things with a higher chance for addiction and there will be a huge difference in what his day will be like if he takes ibuprofen for pain versus morphine.

But really, if you show him taking his medication responsibly and describe how it helps because of how bad his symptoms are without it, it likely won't give the wrong impression. It's not like he would be randomly pulling a random Vicodin out of his pocket and taking a pill whenever he feels like it, he would take his medications at certain times, with certain amounts of time between doses, or in extreme circumstances like taking something for a panic attack. If you write him using his medications as he should and being careful (in my experience, usually a bit overly careful because he really wouldn't want to go through substance abuse all over again,) you won't have a problem. Writing about him using medication responsibly won't look like him recreationally abusing substances. I think you should be fine.

If you have any questions about using medication with a history of substance abuse, feel free to send an ask!

Mod Aaron

[writingdrugs]

Hi there! Obligatory first post, my name is Ambrose and I’m 21 with both a passion for writing and harm reduction.

I’m currently studying to be an addiction counselor and I frequently do volunteer work in the harm reduction community alongside people who use drugs.

Feel free to ask any questions about the impacts of certain substances on a character’s behavior, what drugs may lead to certain kinds of behavior, and how to sensitively write characters who use drugs and/or have substance use disorders.

Please know that all of the info on this blog is meant to be used for fictional purposes and not IRL harm reduction advice. Please seek out many great communities online such as the R/Drugs Discord or the Bluelight Forum/Discord if you need help with harm reduction related needs in your personal life.

People of all ages and genres may ask questions, but I do request that minors block the “erotica” tag if they follow this blog.

Thank you and happy to have you here!

[scaribunpsychiatricservices]

When it comes to dealing with substance use disorders, finding effective treatment options is crucial. Psychiatric services in San Antonio, Texas offer a range of interventions, with Medication-Assisted Treatment (MAT) being one of the most effective. MAT combines medications with counseling and behavioral therapies, providing a holistic approach to recovery.

[wsccinci]

Decoding Addiction Treatment: Exploring Drug Rehab and Treatment

Meta-description: The labyrinth of Addiction Treatment can be confounding. Our meticulous exploration illuminates all components of therapy, imparting invaluable wisdom and pragmatic resources. Foreword Embarking on the path of recuperation from substance misuse can seem formidable. This composition, “Decoding Addiction Treatment,” endeavors to navigate you through each phase of this…

[genderqueerdykes]

i know this won't be available everywhere, but especially if you live in a larger city where a lot of folks are affected by opioid use/addiction, it's a really good idea to ask local pharmacies, and even food banks if they are giving out free narcan (naloxone). this can also be found at certain behavioral health offices as well, my case manager is able to get them for me for free. narcan is a life saving medication that can temporarily halt an opioid (oxycodone, hydrocodone, heroin, fentanyl, codeine, morphine, etc.) overdose while you wait for emergency medical services to arrive.

opioid overdose is distress of the respiratory system, meaning that the person overdosing likely is struggling to, or can't breathe at all. it's very important to watch to see if the person is dealing with labored or shallow breathing.

here the official use guide:

[Image ID start: Two screenshots from the FDA's Narcan (Naloxone HCl) Quick Start Guide infographic. It reads:

"Narcan (Naloxone HCl) Nasal spray quick start guide. Opioid Overdose Response Instructions.

Use NARCAN Nasal Spray (naloxone hydrochloride) for known or suspected opioid overdose in adults and children.

Important: For use in the nose only.

Do not remove or test the NARCAN Nasal Spray until ready to use.

1.) Identify Opioid Overdose and Check for Response Ask the person if they are okay and shout name.

Shake shoulders firmly and rub the middle of their chest.

Check for signs of Opioid Overdose:

Will not wake up or respond to your voice or touch

Breathing is very slow, irregular, or has stopped

Center part of their eye is very small, sometimes called "pinpoint pupils".

Lay the person on their back to receive a dose of NARCAN nasal spray.

2.) Give NARCAN nasal spray

Remove NARCAN nasal spray from the box. Peel back the tab with the circle to open the NARCAN nasal spray.

Hold the NARCAN nasal spray with your thumb at the bottom of the plunger and your first and middle fingers on either side of the nozzle.

Gently insert the tip of the nozzle into either nostril.

Tilt the person's head back and provide support under the neck with your hand. Gently insert the tip of the nozzel into one nostril, until your fingers on either side of the nozzle are against the bottom of the person's nose.

Press the plunger firmly to give the dose of NARCAN nasal spray.

Remove the NARCAN Nasal Spray from the nostril after giving the dose.

3.) Call for emergency medical help, Evaluate, and Support

Get emergency medical help right away.

Move the person on their side (recovery position) after giving NARCAN Nasal Spray

Watch the person closely.

If the person does not respond by waking up, to voice or touch, or breathing normally another dose may be given. NARCAN Nasal Spray may be dosed every 2 - 3 minutes, if available.

Repeat Step 2 using a new NARCAN Nasal Spray to give another dose in the other nostril. If additional NARCAN Nasal Sprays are available, repeat step 2 every 2 to 3 minutes until he person responds or emergency medical help is received.

For more information about NARCAN Nasal Spray go to www.narcannasalspray.com, or call 1-844-4NARCAN (1-844-462-7226)."

End image ID.]

[healingdemeter]

When someone has a substance use disorder, there is this harmful belief that 12 Step programs are the best and only treatment of choice. While some people find 12 Step programs helpful, others don’t, and rather than trying to find something that works well for them they are encouraged to try harder.

While some people with gender dysphoria may benefit from Gender Affirming Care and transition, others don’t. And there are other treatments available and pathways available. You can have gender dysphoria and you can find contentment without transitioning. People need more options than to just try harder at something that isn’t working for them.

[gravity71]

Shattered “Gremlins Versus Meth” Substance Use Disorder

I’ve found many challenges in my life when I was asked to elaborate on unmasking “Meth” and the disorder in the brain of my son’s Substance Use Disorder (also referred to as Addiction in other Supportive Networks) who is no longer a child. Trying to explain how my son functions without labeling him with a stigma. Meth is a powerful source of potent chemicals and poisons that produces havoc on…

[neuroticboyfriend]

a lot of the time, abusers are just regular people. abuse is something we're all capable of - it's a pattern of harmful behavior in which there's power imbalance. we all hold various privileges, connections, and knowledge that can be turned into the power to abuse others. we can all exert our will, thoughts, feelings, etc. onto others in a way that hurts them and takes power away from them.

abusive people have done something horrible and inexcusable, yet they aren't... inherently special. they're people, capable of choosing between right and wrong, capable of change, just as much as others are. i say this in part because i think a lot of people have this lofty idea of abusers that leads them to think they couldn't possibly be a victim of abuse. but abuse can be incredibly mundane - and this also means we all have to watch out for abusive behaviors in ourselves.

abuse isn't just something Obviously Bad People (TM) are capable of... and abuse isn't caused by mental illness, substance use/addiction, gender, etc. etc., even if these things impact what happens. idk. there's no real end point to this post. i just wish people didn't mystify abuse, and realized how (deeply unfortunately) normal and subtle it can be... and often is.

[autopsyfreak]

if you shit on people for being drug addicts then just know that i hate you.

[imbecominggayer]

How To Write Characters With Addiction

From @differentnighttale: "I am curious if you give advice about writing people with addictions for example substance. I have reasons my male MC does it. But how can I describe the addictions the MC has correctly."

In this post we are going to be talking about addiction! From alcoholism, substance abuse, nymphomania, to everything else that can be a possible addiction. This post will be all about making this realistic and complex :)

A) What Are The Benefits?, Make It Convincing

Grab a fucking piece of paper or whatever you have and just write a paragraph from your addict's perspective on the situation. Omit the bad stuff. Make it highly convincing. if you aren't thinking "hmm, understandable" after you've written and read it, you did it wrong.

What do they get out of it?

Why did they like it at first?

Are they calmer, more intensely concentrated, does it take the edge off?

Are they more confident?

Does it ease the sense of being fundamentally wrong or dull some other pain?

Is it fun to do something rebellious?

What made them like this thing so much they tried it again, and again, and again?

B) Think About The Consequences, And Ignore It

Oftentime, at least in my experience, people will continue with a bad habit if it means they don't have to be the one to think about the consequences.

The Consequences For Addiction Include:

Financial. Depending on what your character uses to get their fix and how much they use, they might be spending hundreds a week if they are a particularly aggressive user. People often steal money from their loved ones. Addiction also tends to get people fired. Write a scene where your drunk character gets fired for operating machinery. Have them be a burdenous sponge.

Social. It's common for addicts to lose their loved ones since it often gets to a point where it's impossible to care about these people despite how much you love them. Make love ones leave your character! And don't blame them

Physical. STDs, Overdose, Liver Failure, and a shit ton of other issues from the chronic to the fatal either cause, exacerbate, or are linked with addiction. Recovery can't automatically save your character so don't write that story.

Psychological. Being an addict isn't fun since you get to struggle with points 1, 2, and 3 all at the same time! Write about your character issues. Their lack of control. Their spiralling life.

Write all about your character's suffering. And then have them justify it. Make it convincing.

They need it. It's not their fault that this is the only that helps them! Everyone just doesn't get it. I'm trying to work on it, OK?! It'll all work out! They know that it's wrong but...

My most hated shit is when a character's arc is easy. They struggle with some things like a big dramatic argument with their wife, they cry a bit, and then they learn that "drugs are bad" so everything is fine :D

NO!!! Why don't you write about a friendship that doesn't get mended? A chronic illness they now have to pay huge medicine bills for? A fucked-up rap sheet that they can't escape?

And it's not because we want to punich addicts. It's because it doesn't matter if you care about addicts if you don't care about the messy shit!

It's easy to sympathize with an addict if you make them the most innocent victim who never hurts someone intentionally and who gets rid of the addiction in a second and never struggles with it ever again!

Do the hard shit. Make your readers sympathize with the unsympathetic asshole addict! Addicts aren't always good people! They can be dickbags. And they still deserve resources. Life isn't some kind of karma game where dickbags suffer and good people rise! Everyone deserves to not suffer!

Addiction is ultimately a disease. But it's a disease that can make someone you love into an absolutely unlikeable person. And this is coming from someone with an alcoholic dad <3 He does good things and bad things. I can sympathise with my dad and not let him walk all over me.

C) Withdrawal Is Leaving An Ex, Relapse Is Returning

Addiction is a motherfucker trying to leave. It's basically the equivalent of a clingy ex who keeps contacting you, asking for just one conversation, and the moment you so much as acknowledge them you are fucked.

And suffering the brunt of a clingy ex who won't take the hint tends to cause the same symptoms as withdrawal!

Obviously, withdrawal symptoms depend on what type of ex you have and what age you are and yada yada yada. Research for specificity :)

Withdrawal symptoms can include:

Headaches

Insomnia

Fatigue

Hallucinations

Seizures

Tremors

Cravings

etc.

BE AWARE: Relapses are when someone returns back to their drug if they were going cold turkey or going back to their original dose. Relapses can sometimes result in an overdose due to the fact that the brain has been weened off the substance and is now overwhelmed by the high dose.

Relapses often happen when a person makes the deliberate choice in order to stop these fucking nightmarish symptoms. To use the analogy of a clingy ex, you start talking to them in order to tell them to stop contacting.

Relapses can also happen through being in a setting where the behaviors associated with the addiction such as sex, gambling, drinking, substance use, and all manner of things are normalized.

This setting could be a party, a bar, or even a friend group.

Relapse is made more likely if someone is self-detoxing away from a support group or a doctor.

Writing about withdrawal and relapses are an important part in making a story feel more authentic. Just like with mental illness, people rarely learn the lesson and follow it perfectly. They make mistakes. Slip back into old habits. Do shitty things.

We aren't writing their suffering to punish them. We are doing it because you can't say you care if all you are willing to do is look at the easy parts.

D) Little Tidbits To Keep Track Off

This is the miscellanious things that didn't fit into their own boxes.

Friends!

Do they have friends who also have their addiction? How do they hang out? What are they like? How are their substance using friends different from their non-addict ones?

Slang!

Don't just look up slang for your substance of choice. You'll need to look at some first-hand accounts of addiction. Find an influence who has struggled with substance abuse in the past and see how they talk about it!

Variables!

Remember to keep their geographical location, socioeconomic status, time, and a host of other factors. If your character is a penniless alcoholic then it's unlikely they'll get their hands on some type of expensive gin. They'll probably use rubbing alcohol. Keep the price of your drug in mind.

A character's status will also impact their slang. No one unironically says doobie anymore.

A character's location will also impact how they get their shit and how other characters will react to that addiction.

A character's financial status also impacts how the consequences of their actions impact them. A low-income character wont be able to afford the same medication as a rich addict. They also won't have the same luxury for quality therapy, rehab, programs, time, anything really.

Look At The Addict And The Loved Ones

Try not the skew the reality of addiction to paint the addict as the victim and the loved ones as evil for not being forgiving and tolerant enough.

Keep sympathy for both the addict and the loved ones. Or drop sympathy for both of those characters.

E) RESOURCES

FDA and DEA online databases and drug resources

Social Networking Groups

Medical Journals

Local medical professionals, police, and medical examiners

The US national poison center

[snapnarcissisticabuserecovery]

[hussyknee]

You know what the worst fucking thing about liberal rhetoric is? Using "harm reduction", a term that refers to health policies offering safe options and alternatives for drug users instead of punitive control, to rationalize re-endorsing back into power a regime that is still overseeing one of the worst human atrocities of the 21st century.

[annabelle--cane]

you! person who talks about how "everyone has an addiction" and mainly means phones/video games! quick quick, tell me how you feel about people who compulsively use drugs!

[red-umbrella-811]

This one’s for all my friends on here with problems.

If you’re having a trauma or anxiety episode, if you’re thinking about killing yourself, you just need to make it through tonight. The morning won’t make everything good, but things will be better.

Do what you need to do. If you’re struggling to make it through this moment, there are things like exercise for anxiety, cold water on the face for anxiety or flashbacks, other distress tolerance skills. Use your skills, white knuckle it. Don’t use substances or behaviors. Surf the urge.

Try to get some sleep. It’ll be better if you do, but the morning will still be better than the night if you don’t. If you can’t sleep, see if you can lie down and listen to or watch something comforting, maybe with your eyes closed.

If you can’t do that, see if you can be kind to yourself. Maybe that feels natural right now, maybe it doesn’t. Maybe you don’t deserve it. Try it anyway. If there’s some cosmic (or literal) debt to be paid for it, you can pay it in the morning.

Try to be kind. If you can eat, eat something comforting. If you’re in a bed or couch, maybe curl up with a soft blanket or stuffed animal. Smell something that smells like home.

This isn’t about solving the problem, this is about getting you to a place where solving the problem might be possible. It’ll probably take more than a night. But right now, we’re just making it through to see the sun again.