I have a history of longterm physical, emotional and childhood sexual abuse lasting approx 14 yrs. There have been many other stressors involved including the death of my first child, the suicide of a previous lover (although we had not been involved for many years before it happened), and a traumatic divorce. I've made five suicide attempts, starting at age 16. I'm currently 38 yrs old.

I have been diagnosed with bipolar 2 disorder, PTSD, and borderline personality disorder in the past. I also have a diagnosis of chemical dependency.

I spent over six years in weekly therapy attempting to work on the trauma issues, but was unable to resolve them. I can talk about my abuse issue intellectually with anyone, but the moment it starts to get emotionally involving for me, I shut down. You can imagine how frustrating this was after six years.

Every time that I've been admitted to the psych ward following a suicide attempt, I've tested positive for substances and was subsequently referred to addiction treatment. I'm currently again in IOP treatment for drug addiction to opiates. I am not currently on any medication and am not in therapy, other than the addiction treatment which has never been successful in the past (due to my "inability to understand that all my problems are caused by drug use and that if I just stop using, everything will be fine").

I've recently been researching studies done regarding the phenomenon of endorphin release caused by PTSD triggers (such as therapy sessions) often causing numbing and inability to resolve those issues (which is what always happened to me in therapy, I shut down) followed by an endorphin withdrawal afterwards leading to using drugs to increase the endorphin levels. The problem is with getting anyone to see that this is more than just an addiction problem.

I noticed a clear example of this in myself over the weekend. Saturday morning's therapy session had something very intense happen and when it did, I felt that first rush of emotions, then I blocked it out. I switched over into this calm rational person and by the time I left there, I was literally high. I would not have felt any higher if I had taken drugs right then. I was floating. Within hours, I crashed, felt that restlessness and irritability coming on. So, I went and hung out somewhere that had always given me a bit of a rush before (skydiving is an interest/hobby and I just went and watched people skydive for a few hours). I left there feeling good. By Sunday morning, I was rock bottom.

There are times that I have no problems staying sober. I walked out on my last therapist in November 2007, mainly out of just frustration during the last session, and never went back to him. Within the following weeks, I quit using all drugs, alcohol, even smoking. I was able to work on rebuilding a lot of things that I had thrown away during the previous six months which had been very traumatic months for me. I can honestly say that I was doing well.

Mid February, I went on vacation and during that vacation, experienced something that in retrospect triggered me hard on my PTSD. Immediately upon return, I went off onto a binge, even using much harder drugs than I ever had, such as heroin. I even started smoking again. Everything came back, the suicidal thoughts, sleep problems, irritability, everything.

Every study I've read (and I've researched this an incredible amount in the last week) has indicated very poor recovery rates for addicts who are not treated concurrently for their PTSD as for their addiction. However, of course, "the issue is that I just need to stop using drugs". Okay, I get that. I've been clean for ten days now. Guess what kicked in this Sunday after all that other stuff? The urge to cut...something I haven't even thought about in four years. When I brought it up today, the answer was "that's common for addicts that self-mutilate. You are looking for a release."

Okay, yeah, exactly, but if the PTSD isn't resolved or at least dealt with, I WILL use again. I've been through this too many times to have any different thoughts about it. Their issue is that as long as I have addiction issues, then the PTSD can't be dealt with. It's a maddening cycle.

This can't continue. I can stay sober for now, for a while. But eventually, the PTSD *will* trigger me again at some point and I know that I'll be using again. This last event took me from reasonably stable to suicidal within a matter of weeks.

There's been some studies into using naltrexone during PTSD treatment to prevent that endorphin release and enabling the patient to remain "in the emotions" during therapy, but I've not been able to find a therapist that seems to have even heard of that.

I guess I'm just looking for other opinions on this. I'm just tired of being treated like there is nothing wrong except that I use drugs and just need to stop that.

Thanks.

You bring up a lot of interesting and I believe valid points. In a nutshell you sound a lot like me, although I haven't wanted to harm myself in a very long time and don't feel like I will.

Your observation on feeling the 'rush' after an intense session is a revelation for me. I also have issues using opiates, to tamp down intense emotional reactions due to PTSD triggers, and I suspect the relational issues are similar for a lot of other people.

Unfortunately I don't have any insight beyond what you bring up; I just wanted to let you know that it feels pretty accurate. Hang in there and please try not to harm yourself right now. I think you know that until you allow yourself to 'feel' and tackle the PTSD, you're not going to make any progress.

I had to find a T that I absolutely knew was 'safe' for me, and once they convinced me that 're-telling' the trauma was not the same as being re-victimized, I was able to start to face it and integrate it into my life safely.
Everyone gets to that stage in their own way. I hope you are able to do it for yourself.

Hi BSBD,

I too have a history of substance abuse, and depression and also PTSD. In a couple of weeks I will reach two years 'clean'. I relapsed two and a half years ago, after twenty years of 'recovery'.
It is indeed the case that because in all those twenty years I never properly dealt with the underlying issues, that even after so long, relapse was almost inevitable, and it was devastating and took me to places I hope never to revisit.
That said, however, it is my experience that to delve to deeply into heavy duty emotional stuff before having established a stable pattern of sobriety, including beginning to learn some healthier coping mechanisms, and also developing a good support system of professionals and friends / family, is a recipe for relapse every time. I have seen this not only in myself, but in the many, many other recovering people I have encountered. I spent a year in a recovery home, with 24/7 support and it was only towards the end of that year that I was actually ready to get into things more deeply. I have been out on my own for 10 months now, and still feel I am just getting started.

I also first reverted to cutting and then a previous eating disorder resurfaced...only now, two years into a renewed recovery I am choosing healthier options with greater consistency, but then again, I started smoking again occasionally. All that to say that it is hard, hard work to actually turn and face the real issues. Work that cannot be rushed, and which requires a lot of help from others.

So...patience, my friend...a clear head is the way to begin. The rest will come in time if you persist.
My heart is with you.

I am quitting smoking at this time. The doctor prescribed Chantix. The first day I used it, I felt euphoric. Not over the top, but a real feeling of happiness. I had already quit the anti-depressant, Celexa, over the previous 2 months. I have now been taking Chantix for the last 4 weeks.
The reason I am bringing this up is because I haven't done the numb thing when I have been triggered. I haven't been taking ativan constantly. In fact, I have only had half an ativan in the past 2 weeks.
I have found out that chantix blocks the dopamine release that cigarettes give you. What I have been trying to find out isif it also is blocking the chemical imbalance that causes the over top feelings we get from our PTSD. No one can answer that.
Now, I have had some emotional crying, some small feelings of fear, but I didn't block them...I HANDLED THEM! You know, like before, when I used to handle things normally (I think LOL).
I would love to find a study or talk to someone, because this could really be important for us!!!!
I mean, I have been living with my sister and in a rehabilitation center part of the time for the past 3 years. I am now trying to get my own apartment. I would have never thought I was ready, but I feel so normal (well for me) and if this could help others, I want to find out because all the things they give us are standard "treat the symptoms" drugs.
This could be a whole new angle to look at our treatment.
Oh, and by the way, I haven't had a cig since last Thursday!
Please, respond to this and tell me what you think, because what BSBD is saying really relates to this, I mean, our unconcious brain will drive us to taking drugs to keep it on the same level of alertness and the pleasure response...even if it doesn't feel so pleasurable to us.

BSBD please do not start self harm. It is an OCBD and it goes along with eating disorders. I found that it was nearly impossible to get over the eating disorder so I think once you start self harm it will linger for a very long time.

I was addicted to Demerol after a month long stay in the hospital where I was given shots of Demerol every 4-6 hours. It took years to get over that.

I still struggle with the eating disorder. Some times I over eat and some times I won't eat at all, which is a way to punish myself and prove I can control what happens to my body.

These things take time to resolve. Keep working on your healing, and in my opinion don't substitute self harm for drug use. Because you will be doing both instead of just one. Self harm will substitute for drug use and vice versa when in need for that release.

Peace
Tammy

I don't have time this morning to respond to all of these, but I will do so over the next couple days. I just didn't want you to be concerned that I was going to actually start self harming again.

I was a pretty heavy duty self harmer up until 2003, when I was able to stop and haven't done it but once since then. I've had periods of sobriety before and never experienced a pull like that to cut again, until this time. I think that's why it surprised me so much.

I still can't get the hospital that's doing my outpatient addiction treatment to set up an actual appointment with a therapist. However, they were willing to schedule an appointment with the psychiatrist for in a week to see if I need to be on meds. *laffs* The thing is, normally, I'm vehemently opposed to psych meds.

Gotta run, but thank you for the concern (that goes for what everyone has had to say).

Blue Skies