detox - working through it - nhsaaa.net · detox - working. through it. addiction services. 4. all...

Detox - working through it

Addiction Services

All our publications are available in other formats

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.

AS09

-001

-GD

PI

L17-

0324

Appointments Detox - working through it

Date Time Date Time

2

Contents Detox - working through it

Page number

Introduction 5

Recovery 6

Preparation for detox 8

Units page 9

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

Acknowledgements Detox - working through it

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

4

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

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

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

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

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

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.

"U:< ChlC'f Medical Offlccrs'low risk drinkins Bllidclincs., Aueust 2016

drinkaware

10

...OR this amount of spirits

...OR this amount of cider

...OR this amount of lager or ale

Low risk alcohol guidelines for men & women*

14 units a week

To keep health risks from alcohol to a low level it issafest not toreeularly drink more than

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

Diary Detox - working through it

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?

Example:

Day /date

6pm Strong cider

Fellow drinkers

In friend’s house

Two litres Got drunk and argued

Bad: let others down, fell out with friends

16.8 £4

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Total units /cost a week

12

Diary Detox - working through it

Day Time What did

you have? Who were you with?

Where were you?





Example:

Day /date

6pm Strong cider

Fellow drinkers

In friend’s house

Two litres Got drunk and argued

Bad: let others down, fell out with friends

16.8 £4

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday


13

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

Reasons for using alcohol, drugs or both

Reasons against using alcohol, drugs or both

Short term

Long term

14

Why do I want to stop? Detox - working through it

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.

15

Future The concerns or worries I have about the future are:

Present

The problems I have in general are:

Before detox

My reasons for deciding to stop are:

Goal setting Detox - working through it

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

The ways other people can help me are:

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 most important reasons why I want to make these changes are, for example - health and family reasons.

The changes I want to make are, for example, to be completely free from alcohol.


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

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

Eating matters Detox - working through it

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

•


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-

6-8 a day

\ 9; \))

6. <O

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

T 2500kcal = ALL FOOD + ALL DRINKS

0 Crown copyright 20 16

Per day 2000kcal

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

• 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

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

Medication Detox - working through it

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


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

Sleep Detox - working through it

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

Cues and triggers Detox - working through it

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.

1. 2.

3.

4.

Note down alternative way of responding to these warning signs.

Example: walk to another bus stop.

1. 2.

3.

4.

You may want to continue on the notes page.

28

Notes

Note down


Note down some warning signs. Example: bus stop I use has off-licence next to it.

1.

alternative ways of responding to these warning signs. Example: walk to another

bus stop.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

29

Relapse issues Detox - working through it

Lapse: this means you are using again on occasions.

Relapse: 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


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

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

0 1 2 3 4 5 6 7 8 9 10

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

Anxiety management Detox - working through it

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

Anger management Detox - working through it

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


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


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 Time of day A For example: Saturday 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


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


Sources of help and information

Adfam

Adfam is the leading national organisation working with and for families affected by drugs and alcohol. www.adfam.org.uk

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.

www.activescotland.org.uk

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.

www.alcoholconcern.org.uk

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.

www.drugscope.org.uk

39

http://www.adfam.org.uk/

http://www.activescotland.org.uk/

http://www.alcoholconcern.org.uk/

http://www.drugscope.org.uk/

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.

www.sdf.org.uk

Scottish Drug Services

This online directory has been developed to help people find information on all drug treatment and rehabilitation services in Scotland. www.scottishdrugservices.co.uk

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. www.scottishrecovery.net

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. www.smartrecovery.co.uk

40

http://www.sdf.org.uk/

http://www.scottishdrugservices.co.uk/

http://www.scottishrecovery.net/

http://www.smartrecovery.co.uk/

Useful numbers Addaction, Kilmarnock 01563 558777

Addaction, Ayr 01292 430529

Addiction Services: NHS Addiction Services – East Ayrshire 01563 574237 North Ayrshire Drug and Alcohol Recovery Service 01294 476000 NHS Addiction Services South Ayrshire 01292 559800

AdFam 02075 537640

Al Anon Family Groups (Scotland) 01413398884

Alcohol Concern 0207 2640510

Alcoholics Anonymous 0141 2217356

Ayrshire Councilon Alcohol 01292 281238

Breathing Space 0800 83 85 87 Families Anonymous 0845 7697555

Ward 5 Woodland View 01294 322377


41


National Alcohol Helpline 0345320302

National Drugs Helpline 0800776600

NHS24 111

Prevention and Service Support Team (NHS Addiction Services) 01294 322339

Samaritans 08457909090

There may be local support services in your area, please ask your worker about these.

42

Notes


43

Diary


Day Time What did you have?

Who were you with?

Where were you?





Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday


45

Diary


Day Time What did you have?

Who were you with?

Where were you?





Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday


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.

0800 169 1441 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 email us at: [email protected]. 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: AS09-001-GD PIL code: PIL17-0324

mailto:[email protected]

detox - working through it - nhsaaa.net · detox - working. through it. addiction services. 4. all...

Documents