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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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47 yr old Male. 2007 started using Oxycodine, snorted it.

Resolved Question:

47 yr old Male. 2007 started using Oxycodine, snorted it. About 2011 started using herion via vein injection. Been clean for 3 weeks but needs mental diagnosis because he has high anxiety, has panic attacts. Hasn't worked since 2008. Not capable of facing people, especially job related activities. Grandmother, mother and 2 nieces in his family have been diagnosed with bi-polar. Needs help badly, where do we start?
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 5 years ago.
Hello. I believe I can be of help to you with this issue.

He may be drug free, but his battle with his Oxy addiction is really just starting. He needs a really good clinical or counseling psychologist or clinical social worker (not an addiction counselor) to help him over the next 6 months to year (YES, it takes this long for one's brain to really normalize---I promise you this!!). He is utterly conditioned or has a strong learned coping strategy for managing all forms of stress and NORMAL anxiety---just escape and avoid through numbing out with medication. He has to re-learn how to tolerate anxiety and stress, rediscover that it is perfectly normal, won't kill anyone, and can be MANAGED through many emotion regulation skills-----other than the one he has been using for several years which is medication.

So he will fee quite lousy emotionally and psychologically for many months because he must adjust to the normalization of his brain; figuring out how to handle normal people in normal stress situations with drugs. He will have to learn a ton about the situational cues in the environment and his thinking and self-talk, because these are intimately linked with drug use. When he encounters a stress situation he has until now, learned to avoid through upping his oxy dose, he may no longer have the oxy, but he WILL experience drug cravings and even pseudo withdrawal symptoms IN THAT SITU:ATION. And there are mental 'situations', mental scenarios and patterns of thinking that will trigger the emotions of craving as well. He needs to be working with a therapist who really understand relapse issues, learning and conditioning factors in drug use and relapse, etc. He needs a ton of firm, but kindly social support.

So I've outlined just a few of his needs and what he will face during the next year or so. He HAS to realize that he has stared on the first foot or two of a long journey back to health and he MUST learn to accept his emotions, accept the fact that he must and can learn some new emotion regulation skillls, he has to learn that strong negative feelings are just feelings and won't kill him; he has to gradually learn to like himself again (which will come in part through social support and increasing days of full sobriety and vocational progress, or educational/training progress, etc.) My main message is that there is a ton of stuff to be done in the next year that will require incredible patience on his part, with himself. One step might be to share this post with him, as I doubt he is coping at all well with the post-detox frustrations and the beginning symptoms of emotional and 'brain' readjustment that only changes very slowly. He may experience mood swings, bouts of extreme irritability and depression----this is all perfectly normal stuff for the year following detox, if one has been using as long as he has.

Patience----stay in his outpatient program, go to group, attend NA if possible, get a good individual therapist who really knows this stuff. He appears to have started on the right path in terms of basic help and resources, based on what you've listed under Already Tried.

I'll pause here and solicit your reaction to this post so far.
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