Detox - working through it

Transcription

1 Detox - working through it Addiction Services In this workbook, detoxification or detox refers to the process of becoming alcohol or drug free. This workbook will help you in the detox process. All our publications are available in other formats AS GD PIL

2 Appointments Date Time Date Time 2

3 Contents Introduction 5 Recovery 6 Preparation for detox 8 Units page 9 Page number Keeping a record or diary 11 Reasons for and against using alcohol, drugs or both 16 Why do I want to stop? 17 Problem solving 18 Goal setting 19 Eating matters 21 Medication 27 Driver Vehicle Licensing Agency 28 (DVLA) Sleeping 29 Cues and triggers 30 Relapse issues 32 Dealing with risky situations 34 Craving 35 Anxiety management 37 Anger management 39 Making the most of your leisure time 41 Sources of help and information 43 Diary 46 3

4 Acknowledgements Special thanks to the people who used this workbook for their contribution of comments and suggestions. 4

5 Who is this booklet for? This booklet is for people who want to detox from their substance use. This is for drugs and/or alcohol. If you are considering going through detox, please discuss this with your family doctor (GP), nurse, clinician or drug worker before stopping. How should you use this booklet? You should have received this workbook from your worker who will guide and support you to work through it, and as the workbook is yours, it allows you to progress at your own pace. When you think about the problems you have from alcohol, drugs or both, does it automatically make you stop? The answer is probably no. There are many behaviours people need to change, but it sometimes takes specific thoughts, feelings or circumstances to create enough motivation to finally do it, such as: Physical needs - for example, someone stops smoking when they find themselves breathless when walking. Psychological processes, such as modelling - being inspired to copy someone else s success in achieving what you want. Cognitive processes - thinking about what you want to achieve or change in life. External events or circumstances beyond our control can create an immediate change without much conscious thought at all - for example, bereavement, life-threatening event or divorce. 5

6 Recovery Recovery means different things to different people and no two people will have the same journey of recovery. Your worker will use a number of methods to help you move towards understanding how to promote, support and interpret recovery from problematic substance use. Experience has shown that recovery is about giving people the tools to become active in their own health care it is about having the belief, drive and commitment to the principle that people can and do recover control of their lives. Clearly, there are many factors which may help in your personal recovery. This workbook will bring together thoughts and ideas, invite comment and input which will help us gain clearer insight into what helps, and what delays, your road to recovery. Are you ready to change? This information will help you decide if you are ready to give up your substance use. Look at the diagram on the next page to decide what stage you are at in the cycle of change and write it down at the bottom of the page. 6

7 Cycle of change PRECONTEMPLATION RELAPSE CONTEMPLATION MAINTENANCE ACTION Prochaska and Diclemente At the moment I am at the stage of: The model has several stages which include: Pre-contemplation: My partner thinks I am dependent, but I could stop if I wanted Contemplation: I know I m getting into debt through drinking, but I like the buzz Preparing / action: I ve made an appointment to see someone to help sort out my problem Maintenance: I ve been sticking to my programme and nothing else Relapse: I m using again to top up my reduction programme 7

8 Preparing for detox It is best not to stop drinking abruptly as alcohol withdrawal carries risks such as having a seizure or experiencing delirium tremens (DTs), it requires careful clinical management. We would advise you to reduce and stabilise to prepare for detox. Now you have decided to detox, there are some simple steps that you can take to make the process slightly easier. Timing is important choose a quiet period where you have no major distractions or additional stress - for example, avoid school holidays, New Year, wedding celebrations. Ideally you should have identified a supporter who will be company for you. You should be able to discuss difficulties with this person. They will also be expected to help monitor your medication. Explain to those around you that you will be detoxifying. Ask friends/relatives not to bring drink or drugs into your home. Let people know that you may be anxious or even irritable at times. In the days leading up to your detox try to stabilise or slightly reduce your drinking or drug use. The evening before you start detox, try to dispose of remaining drink/drugs or containers. 8

9 Government Alcohol Guidelines The Chief Medical Officers (CMO) guideline for both men and women states that to keep health risks from alcohol to a low level: It is safest not to drink more than 14 units a week on a regular basis If you regularly drink as much as 14 units per week, it s best to spread your drinking evenly over three or more days. Single occasion drinking Drinking a lot of alcohol on one occasion can increase the risk to your short-term health; for example you re more at risk from falling over and injuring yourself, misjudging risky situations or losing self-control. The Chief Medical Officers (CMO) advice for men and women who want to keep their short term health risks from single occasion drinking to a low level is to reduce them by: Limiting the total amount of alcohol you drink on any single occasion Drinking more slowly, drinking with food, and alternating with water Planning ahead to avoid problems; an example of planning ahead is making sure you can get home safely or that you have people you trust with you. How much is 14 units of alcohol? One unit is 10ml of pure alcohol. Because alcoholic drinks come in different strengths and sizes units are a good way of telling how strong your drink is. It s not as simple as one drink, one unit. 9

10 Detox - workingthrough it The new alcohol unit guidelines are equivalent to six pints of average strength beer or six 175ml glasses of average strength wine. Low risk alcohol guidelines for men & women* To keep health risks from alcohol to a low level it issafest not toreeularly drink more than 14 units a week...or this amount of lager or ale...or this amount of cider...or this amount of spirits "U:< ChlC'f Medical Offlccrs'low risk drinkins Bllidclincs., Aueust 2016 drinkaware 10

11 Keeping a record or a diary The next step in controlling your alcohol or drug intake is to keep a record or a diary of exactly what your habits are. That means keeping a note of what you took, how much you took, where you took it, who you took it with, consequences and how much it cost and so on. Use the alcohol unit calculator below to help you. This is helpful as it highlights just how much you need to cut down, and also shows what your drinking and/or drug taking weaknesses and vulnerabilities are. You may also wish to keep a note of how much money you have spent on alcohol or drugs in a week. This can sometimes be surprising, but is also a useful motivation in helping you to detox. Complete the drink diary on page 14 for a couple of weeks to record your progress. Please ask your worker if you need any more copies. The next page contains an example of how you should fill in the diary. 11

12 Diary Day Time What did you have? Example: 6pm Strong Day /date cider Who were you with? Fellow drinkers Where were you? In friend s house How much did you have? Two litres Were there any consequences? Got drunk and argued Consequences good / bad Bad: let others down, fell out with friends Units How much did it cost? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total units /cost a week 12

13 Diary Day Time What did you have? Example: 6pm Strong Day /date cider Who were you with? Fellow drinkers Where were you? In friend s house How much did you have? Two litres Were there any consequences? Got drunk and argued Consequences good / bad Bad: let others down, fell out with friends Units How much did it cost? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total units /cost a week 13

14 Reasons for and against drinking or taking drugs It may be useful to think about the reasons for and against using alcohol or drugs. By noting them down you can keep them for future reference. The reasons for would refer to what you feel is the good things about using or not using. The reasons against would refer to what you feel are the bad things about using or not using. Decisional balance Short term Reasons for using alcohol, drugs or both Reasons against using alcohol, drugs or both Long term 14

15 Why do I want to stop? This exercise should help in identifying immediate problems. It will help you solve other problems as well. It will act as a reminder of why you chose to detox. Before detox My reasons for deciding to stop are: Present The problems I have in general are: Future The concerns or worries I have about the future are: 15

16 Goal setting The changes I want to make are, for example, to be completely free from alcohol. The most important reasons why I want to make these changes are, for example - health and family reasons. The steps I plan to take in changing are, for example - to stay away from risky situations that would cause a possible lapse/ relapse or engage with family/friends who are supportive of my abstinence. The ways other people can help me are: I will know that my plan is working if, for example - I m not using. Some things that could interfere with my plans are: 16

17 Problem solving approaches Many people find that they increase their drinking/drug use when they run into problems and difficulties in their lives. This, in turn, can create further problems which may make the original ones worse. Here are some steps you may find helpful: Try to stop yourself reacting with oh no I can t cope or my life is a mess because these thoughts make it harder for you to see them clearly. Do not act impulsively Wait, count to ten and say to yourself something like I ve got to stand back and look at this calmly. Spell out what the problems are Do not pass things off, by using vague phrases like my life is no good. Instead be more specific. Think freely about solutions Let your mind run free to come up with any ideas about possible solutions to the problem. The important thing is not to limit your ideas. Make out as many alternatives as possible. Decide on the best solution When you see the problem come up with some possible solutions, go over the most likely ones with your supporter. Then decide on your course of action. Try out the solution See if it works. 17

18 Goal setting in practice Having introduced a problem solving approach, you now have the opportunity to try this out. Once you have worked through a problem, move on to more difficult ones. My problem is: Possible solutions are: The solution I have chosen is: 18

19 Eating matters You may find at the beginning of your detox that eating is the last thing you want to do. Alcohol can reduce your appetite The thought of food may make you feel sick You might simply forget to eat You may feel that you don t have time for food You may feel that food is not important Why is it important to eat? You need food and fluids for your body to work properly; they are essential to provide you with important vitamins and minerals to help keep you healthy. Vitamin B1 is called thiamine. It is an important vitamin, especially if you have drunk a lot of alcohol and do not eat regularly. Your body cannot store it for long, so it is important you get a daily supply from your diet even if you are on tablets. 19

20 Check the label on packaged foods Each serving contains of an adult's reference intake Typical values (as sold) per 1OOg: 697kJ/ 167kcal Choose foods lower in fat, salt and sugars Use the Eatwell Guide to help you get a balance of healthier and more sustainable food. It shows how much of what you eat overall should come from each food group. Choose Wh Ofegrfiir) Potat Orl/i Oes 6 '91/e, rea ""6 tt,,.ce ""eve '' "'sl "<l'o/..,...,, 'S''t,, ">o- '0 00. ii... OO' l d'... QQ: \ 0-9; \)) 6. <O 6-8 a day Choose unsaturated oils and use in small amounts Eat less often and in small amounts Source: Public Health England in association with the Welsh government. Food Standards Scotland and the Food Standards Agency in Northern Ireland Per day 2000kcal T 2500kcal = ALL FOOD + ALL DRINKS 0 Crown copyright 20 16

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22 What foods should you eat? Foods with lots of thiamine include:- Yeast or beef extract, for example - Bovril or Marmite Nuts, seeds and dried fruit, for example - raisins Meat cooked bacon, gammon or ham Canned or fresh fish - for example, mackerel or sardines Breakfast cereals Bread rolls all types Soups homemade, tinned or packet All fruit Here are some ideas for easy meals which will help you start eating again. Breakfast Cereal, porridge with milk Toast with butter and jam or marmalade Boiled or scrambled egg and toast Toasted cheese Baked beans and toast Fresh fruit juice Light meals Sandwich or toastie with cheese, meat, fish or egg Mug of soup with bread/roll and butter 22

23 Bacon roll Baked beans/spaghetti on toast Tinned macaroni cheese with bread and butter Custard or rice pudding with tinned or fresh fruit Yoghurt Main meals Potatoes, rice or pasta Chicken with curry sauce and rice Fresh, frozen and tinned vegetables Gammon steak and pineapple with chips and peas Mince and potatoes with carrots and peas Soups or puddings Pasta with meat and vegetable sauce A ready meal for microwave/oven Red meat, chicken and fish Snacks Scone, pancake or tea bread with butter and jam Cheese and biscuits Yoghurt Pot of custard or rice pudding Fruit jelly Crisps or nuts Plain biscuits or chocolate biscuits Cakes and pastries 23

24 Fluid Try to drink two litres of fluid a day and try to include: Water Diluting juice Milky drinks Horlicks, Ovaltine, hot chocolate Tea/coffee (not strong) Bovril/marmite Fruit juice 24

25 Medication Remember to discuss any medicines that you are taking with your doctor or pharmacist before starting to detox. If you forget to take your detox medication: Take it as soon as you remember, then delay the next doses. If it is close to the time of your next dose leave out the missed dose. Do not take double the dose. Check the label and instructions before you take the medicines especially at night time. Follow the directions carefully. Take tablets and capsules with plenty of water while sitting or standing up. The medicines used for detox may cause drowsiness. You may be less alert or feel sleepy, so do not drive or operate machinery and take extra care when using knives, cookers, electric irons, lawnmowers and so on. Keep track of when you have taken your medicine marking the calendar (which your nurse will give you) by using the chart at the back of this workbook. Do not transfer your medicines into another container. Do store your medicines in a safe, cool, dry place, away from bright light out of the sight and reach of children. Do not share your medicines with anyone else or take medicines prescribed for someone else. If you want more information about your medicines contact your pharmacist. Any medicines which you no longer need should be taken to your local pharmacy for them to dispose of safely. Your worker will provide you with a medicine chart. 25

26 Driver Vehicle Licensing Agency (DVLA) The Road Traffic Act requires licence holders or applicants to inform the Driver Vehicle Licensing Agency (DVLA) of any disability likely to affect safe driving. Alcohol dependency, persistent misuse of alcohol and drug use are considered disabilities in this context. If you have any queries please check with your pharmacist 26

27 Sleep Stick to a fixed time to go to bed and waken up. Avoid napping during the day as it will affect your sleep at night. Exercise regularly, but not before bedtime. Regular exercise can help you sleep better. Make sure your sleeping environment is comfortable and not too hot or cold, and get rid of as much light as possible. Using alcohol and/or drugs affects your sleep pattern. Your body adapts to the alcohol or drugs and therefore it takes time to readjust when you stop using. Medication may help you in the short term. However you should aim to eventually adjust to your normal sleep pattern. Suggestions to help get you back to your normal sleep routine: Avoid tea and coffee in the evening (these contain caffeine which is a stimulant). Try warm milk or camomile tea. A warm bath to relax. Practice relaxation or discuss with your worker. Drink less fluid in the evenings. Count your breaths in and out, up to ten and back to zero. Make sure your room isn t too hot or too cold. Don t sleep during the day. Forcing yourself to get up in the mornings and being active during the day can help you sleep at night. And remember, if you are awake it is better to be up than in bed. 27

28 Cues and triggers As the saying goes, forewarned is forearmed. If you can identify circumstances that may lead you back to drink or drugs (cues/triggers), then you should be in a better position to manage the situation. Note down some warning signs. Example: bus stop I use has off licence next to it Note down alternative way of responding to these warning signs. Example: walk to another bus stop You may want to continue on the notes page. 28

29 Notes Note down some warning signs. Example: bus stop I use has off-licence next to it Note down alternative ways of responding to these warning signs. Example: walk to another bus stop

30 Relapse issues Lapse: Relapse: this means you are using again on occasions. this means you have made a full return to your old behaviours. List some things using the space below that you can do before drinking or taking drugs - for example, take a bath, phone someone who is supportive of you, or go for a walk. 1. Considering the consequences of a relapse is important and could be useful to stop it happening. Think of how you would feel immediately after drinking or using again. How would you feel the next day? 2. A small lapse does not need to lead to a full relapse. It may therefore be useful to note down some of the things you could do if you find yourself in this situation. If during detox you relapse you should contact the service for further information and support. 30

31 Dealing with risky situations These suggestions may be useful for situations when you feel like drinking or using drugs. Stop and think Try to remove yourself from the situation Keep calm. Try to relax (see relaxation section) Do something else: Talk to your support person or people Try to occupy your mind or do something else Think about your reasons for stopping Remind yourself of the costs if you return to drinking/using Remind yourself of the benefits of not drinking/using page 16 (decisional balance) Try to learn from the situation; discuss with your supports These suggestions can also be used if you have already lapsed. 31

32 Craving This page can be useful to note down cravings that you may experience, to see if a pattern is developing and may help you identify useful ways of overcoming these. No craving Strong craving Day Time Strength Lasted how long? What did you do? With who? Describe your feelings What did you do? Did this help? For example Saturday 2pm 6 30mins shop, alone Fed up Bought a topical magazine Yes, distracted self from craving This diary can be a useful on-going tool, to help you review your progress from time to time. You may wish to discuss this with your worker. You can get more copies from your worker if you need to. 32

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34 Anxiety management Anxiety is natural day-to-day stress. At times this can be useful. It can be turned into an advantage and doesn t need to be a negative reaction. Everyone can benefit from controlling their anxiety. The most common symptoms of anxiety are: Palpitations Cold and clammy Fear Nausea Sweaty Confusion Panic Feeling tense Hot flushes Note down the symptoms that you experience when you feel anxious What helps to reduce your anxiety? Medication can help at times; however, it can mask symptoms and may not deal with the real cause. The more effective solution would be learning to use a range of simple relaxation techniques. Relaxation takes some time to get used to and you should practise it regularly. It is also important to continue using the techniques, whether or not you feel stressed at the time. The feeling of relaxation will improve the longer you practice. Relaxation resources are available from your nurse, worker or local library. 34

35 Anger management Anger is an area which may lead to a variety of difficulties. Inability to deal with anger may also lead to relapse. Angry outbursts can be linked to a lapse/relapse. You may direct your anger at others. For example, you may impulsively express your anger to others in a verbal or physical manner, or you may keep all the anger inside and let it build up. Some possible signs of anger are headaches, irritability and tension. Note down some feelings you experience when you are angry: Identify the possible causes of your anger, for example, who else is involved, the time of day and then weigh up the situation. List below the possible causes of your anger: Please write down your usual responses to your angry feelings: 35

36 Note down below how else you could cope with your anger: Here are some useful considerations: Is your anger really justified? It may be an over-reaction to a situation. Would it help to talk directly to the person concerned? Would it help to talk to someone who isn t involved in order to discuss your feelings and gain an impartial view of the situation? Do not allow anger to build up: early action is usually better Sudden anger can lead to a risky situation 36

37 Making the most of leisure time When you stop drinking or using drugs, you will have time on your hands and you may then become bored. It may be useful to plan to occupy this time. Think of your most difficult periods. List below in order from the most difficult to the least difficult. Day A For example: Saturday Time of day For example: afternoon B C D Now list the hobbies or leisure interests you enjoyed doing before your substance use. A For example: going for a walk B C D 37

38 Speak with your worker to find out what resources are in your area. List any new (or old) hobbies or leisure activities you could try Around your home (reading) Outside your home (walking or going to the cinema) People or places to visit (friends) Now consider how you could plan to occupy your most difficult periods by taking up your hobbies or interests. 38

39 Sources of help and information Adfam Adfam is the leading national organisation working with and for families affected by drugs and alcohol. ActiveScotland It doesn t matter what you do - walking, cycling, swimming, dancing or yoga - as long as you do something. It is being active that counts! Visit the Active Scotland website, put your postcode in the search box, chose easy activities, and we ll help you find something to get you started. Alcohol Concern Alcohol Concern is the national agency on alcohol misuse campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. DrugScope DrugScope is the UK s leading independent centre of expertise on drugs and the national membership organisation for the drug field. Their aim is to inform policy development and reduce drug-related harms - to individuals, families and communities. 39

40 Scottish Drugs Forum Scottish Drugs Forum (SDF) is a membership based drugs policy and information organisation and is a national resource of expertise on drug issues. SDF works towards a healthier, more equal society where everyone can fulfill their personal, social and economic potential, drugs-related harm cannot thrive and the needs of those affected by drug use are met effectively and with empathy, compassion and respect. Scottish Drug Services This online directory has been developed to help people find information on all drug treatment and rehabilitation services in Scotland. Scottish Recovery Network The main aims of the Scottish Recovery Network are to: Raise awareness that people can and do recover from long term and serious mental health problems, and of what recovery might mean for people. Build our understanding of what helps people recover and stay well. Build capacity for recovery by highlighting and supporting examples of good practice. SMARTRecoveryUK SMART Recovery UK s goal is to develop a UK wide network of meetings run by volunteers who have first-hand experience of addiction. They welcome enquiries and will assist in getting meetings running where they are requested. They can also offer online support and guidance until there is a face to face meeting where you live. 40

41 Useful numbers Addaction, Kilmarnock Addaction, Ayr Addiction Services: NHS Addiction Services East Ayrshire North Ayrshire Drug and Alcohol Recovery Service NHS Addiction Services South Ayrshire AdFam Al Anon Family Groups (Scotland) Alcohol Concern Alcoholics Anonymous Ayrshire Councilon Alcohol Breathing Space Families Anonymous Ward 5 Woodland View

42 National Alcohol Helpline National Drugs Helpline NHS Prevention and Service Support Team (NHS Addiction Services) Samaritans There may be local support services in your area, please ask your worker about these. 42

43 Notes 43

44 Diary Day Time What did you have? Who were you with? Where were you? How much did you have? Were there any consequences? Consequences good / bad Units How much did it cost? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total units /cost a week 45

45 Diary Day Time What did you have? Sunday Who were you with? Where were you? How much did you have? Were there any consequences? Consequences good / bad Units How much did it cost? Monday Tuesday Wednesday Thursday Friday Saturday Total units /cost a week 46

46 All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, Crosshouse Hospital, Crosshouse KA2 0BB. You can also us at: comms@aaaht.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment Last reviewed: August 2017 Leaflet reference: AS GD PIL code: PIL