Understanding Heroin

Understanding heroinIt’s difficult to find fundamental solutions when a problem is misunderstood as symptomatic of something else – the application of symptomatic solutions to perceived symptomatic problems leads in circles with no real resolution. Heroin, though it’s been around since at least 3400 BC, is still misunderstood. How can this be? Drug smugglers and dealers have a better grasp than our officials tasked with dealing with the heroin problem. They understand the fundamental nature of an addictive drug. They know that addicts come from all walks of life, and that once addicted will pretty much do anything to get the drug. When there’s a demand for a product there’ll eventually be supply. Government efforts to deal with addictive drugs have focused on supply, trying to stop the supply. A current Presidential candidate wants to solve the heroin problem by building a wall at the southern border. Heroin addiction is a not a problem that’s created by porous borders.

Fundamental solutions to heroin addiction, and addiction in general, will originate on the demand side. Prohibition ended in failure because the demand for alcohol overwhelmed restrictions on supply. It’s my sincere belief that if all the money now put in the War on Drugs were put into education, prevention and treatment, we’d be much further along in the development of fundamental solutions.

There are few real conversations taking place across the US that deal with fundamental solutions to the fundamental problems of addiction. Addiction is mainly misunderstood, especially heroin. Below is a list of myths and old ideas from www.alcoholrehab.com that don’t hold true with all addicts:

Drug Addicts Fit a Stereotype

The stereotypical drug addict is somebody who:

* Spends a great deal of time in alleyways in the bad side of town.
* Have legal problems and a criminal history.
* Steal from family and friends.
* An individual who wears dirty unkempt clothing and doesn’t invest much time into personal hygiene.
* They move from low paid job to low paid job or are more likely unemployable.
* Estranged from their family.
* Sad people who have nothing good in their life.
* Drug users are stereotypically under 40 years of age.
* Junkies have no ambition in life.
* They are usually homeless and live in derelict buildings with other junkies.
* They are unable to maintain a healthy romantic relationship.
* They are usually looked upon as a lowlife in their community.

The reality of drug users can differ greatly from the stereotype. Many substance abusers have a well maintained addiction. These are often individuals who:

* Never visit back alleyways in the seedier parts of town. The person supplying them with drugs may even be wearing a suit and working in an office.
* Have never had any legal problems or be on the police radar.
* Most addicts have never needed to steal money from family and friends.
* They may wear expensive clothing and be perfectly groomed.
* They may have a successful career and by highly respected by their peers.
* Many addicts are loved and cherished by their family and friends.
* They can appear at least outwardly happy and be extremely positive about the future.
* Drug addicts can be of any age. There are an increasing number of elderly people who are abusing drugs – it has even been referred to as a hidden epidemic.
* These individuals can be highly ambitions and driven people.
* They may live in a big expensive house.
* They can have a loving partner
* Many addicts are highly respected in their community. Most of the people who know them would not even guess that they had even tried recreational drugs.

The stereotypical image of the drug addict can have negative implications. It makes it easier for people to hide their substance abuse problems. They can kid themselves that so long as they do not fit the stereotype they do not really have a problem.

Understanding the problem as one that can affect anyone, forces the realization that it can be a brother, a daughter, yourself,  a next door neighbor, a boss, a physician, etc. Education and prevention entail deep understanding and a change of mind regarding mood-altering drugs. It takes addiction away from moral judgment to a place where reason, understanding and choices play a larger role. Maybe kids should understand that they don’t have to drink alcohol or smoke pot when they grow up, that a life of abstinence is a good choice. It also means that just because someone chooses to use drugs, it doesn’t make them a terrible, immoral, weak person. If someone develops an addiction problem, it’s a medical concern that will respond to treatment. Once we take the mystery and the myths away, we can rationally, intelligently and objectively search for and find fundamental solutions. Heroin seems like a new, scary problem, but heroin addiction is an old problem – is the same as painkiller addiction to an opioid — both can happen to anyone — both are treatable.

Freedom From Opioid Addiction

I’ve written quite a bit about opioid addiction here. One of the main points I try to establish is that in order to effectively deal with this national epidemic, we must understand the problem and stop stigmatizing addFreedom from opioid addictioniction. I’ve dealt with addiction in general since 1983 — opiate/opioid addiction is perhaps the most difficult to treat. The brain changes brought about by opioid addiction are difficult to overcome. This is an excerpt from an article published at NCBI, The Neurobiology of Opioid Dependence:

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.

One reason the current problem with opioid addiction’s spiraling is that there’s a lack of quality treatment options. There are lots of doctors prescribing lots of medicine, but there’s very little long term treatment planning and delivery. Once the person dependent on opioids feels better by taking a medicine like Suboxone, they think they’re healed and can go on their way, but this is not the case. It takes a long time for the brain changes brought about by addiction to heal. Suboxone can give the person relief in order to treat the problem but Suboxone is not a panacea. If a person once physically, mentally and emotionally dependent on opioids is physically free of the opioid, it doesn’t mean they’re mentally and emotionally free. The mind can still crave the drug even after horrible experiences and many consequences. Obsession with a destructive drug is not rational, and herein lies the problem.

Those who don’t understand addiction apply rationality to the situation — if the drug is destructive, stop using it! Makes a lot of sense, right? To most people it does, and even to the person addicted it makes sense, and they’ll likely agree with the rational solution, even though they still crave the drug. Addiction is a medical condition that doesn’t always respond to rational solutions — I would say “never” but I’ll leave it open for other possibilities. You can compare it to a diabetic on a diet who breaks the diet even though it’s not rational. We can crave and indulge in things that are bad for us. Addiction to opioids and the craving for the drug is a very powerful craving, often overriding judgement, even after the opioid is out of the body.

To be free of the obsession and the emotional crutch of a drug like opioids, it takes time and help. Most people don’t get over the obsession by themselves. It takes a treatment plan and managed recovery. Once quality treatment’s readily available nationwide and standards of treatment are adopted based on best practices, maybe we can deal effectively with this problem and millions will know real freedom from opioid addiction.

Addiction Statistics

Addiction statisticsYes, I know that statistics are boring, but it helps once in a while to stop and look at the numbers. Statistics help put the problem of addiction in perspective. When you read about opioid addiction across the nation, you might wonder if it’s media hype. When someone says that alcohol does more damage than all other drugs put together, you might think it’s just a rationalization to make marijuana legal. Let’s just look at the numbers and let them speak for themselves.

First let’s look at the cost to society in healthcare and lost productivity:

Costs of Substance Abuse

Abuse of tobacco, alcohol, and illicit drugs is costly to our Nation, exacting more than $700 billion annually in costs related to crime, lost work productivity and health care.**

Health Care

Overall

Tobacco

$130 billion

$295 billion

Alcohol

$25 billion

$224 billion

Illicit Drugs

$11 billion

$193 billion

_______________________________________________________________________________________________

The following relate to drug overdoses, covering the major drugs used. Between these two links I’ve provided you ought to find most of the latest statistics:

Revised December 2015

The U.S. government does not track death rates for every drug. However, the National Center for Health Statistics at the Centers for Disease Control and Prevention does collect information on many of the more commonly used drugs. The CDC also has a searchable database, called CDC Wonder.

National Overdose Deaths—Number of Deaths from Prescription Drugs.National Overdose Deaths—Number of Deaths from Prescription Drugs. The figure above is a bar chart showing the total number of U.S. overdose deaths involving prescription drugs from 2001 to 2014. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2014 there was a 2.8-fold increase in the total number of deaths.
National Overdose Deaths—Number of Deaths from Prescription Opioid Pain Relievers.National Overdose Deaths—Number of Deaths from Prescription Opioid Pain Relievers. The figure above is a bar chart showing the total number of U.S. overdose deaths involving opioid pain relievers from 2001 to 2014. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2014 there was a 3.4-fold increase in the total number of deaths.
National Overdose Deaths—Number of Deaths from Benzodiazepines.National Overdose Deaths—Number of Deaths from Benzodiazepines. The figure above is a bar chart showing the total number of U.S. overdose deaths involving benzodiazepines from 2001 to 2014. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2014 there was a 5-fold increase in the total number of deaths.
National Overdose Deaths—Number of Deaths from Cocaine.National Overdose Deaths—Number of Deaths from Cocaine. The figure above is a bar chart showing the total number of U.S. overdose deaths involving cocaine from 2001 to 2014. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2014 there was a 42 percent increase in the total number of deaths.
National Overdose Deaths—Number of Deaths from Heroin.National Overdose Deaths—Number of Deaths from Heroin. The figure above is a bar chart showing the total number of U.S. overdose deaths involving heroin from 2001 to 2014. The chart is overlayed by a line graph showing the number of deaths by females and males. From 2001 to 2014 there was a 6-fold increase in the total number of deaths.
Here’s a site with statistics on alcohol use. Below is a sample:

Family Consequences:

  • More than 10 percent of U.S. children live with a parent with alcohol problems, according to a 2012 study.17

Underage Drinking:

  • Prevalence of Underage Alcohol Use:
    • Prevalence of Drinking: According to the 2014 National Survey on Drug Use and Health (NSDUH), 34.7 percent of 15-year-olds report that they have had at least 1 drink in their lives.18 About 8.7 million people ages 12–2019 (22.8 percent of this age group20) reported drinking alcohol in the past month (23 percent of males and 22.5 percent of females21).
    • Prevalence of Binge Drinking: According to the 2014 NSDUH, approximately 5.3 million people22 (about 13.8 percent20) ages 12–20 were binge drinkers (15.8 percent of males and 12.4 percent of females21).
    • Prevalence of Heavy Drinking: According to the 2014 NSDUH, approximately 1.3 million people22 (about 3.4 percent20) ages 12–20 were heavy drinkers (4.6 percent of males and 2.7 percent of females21).
  • Consequences of Underage Alcohol Use:
    • Research indicates that alcohol use during the teenage years could interfere with normal adolescent brain development and increase the risk of developing an AUD. In addition, underage drinking contributes to a range of acute consequences, including injuries, sexual assaults, and even deaths—including those from car crashes.23

Alcoholism and the Family

alcoholism and the familyFamilies of alcoholic (or other types of chemical dependence) suffer greatly through the disease’s progression. Much has been written and talked about on the subject of alcoholism and the family. Anyone who knows anything about alcoholism knows that it tears families apart and often causes long term psychological problems with family members, yet there are few resources aimed at helping family members. Alanon is the biggest self-help group – it has given comfort and healing to millions of family members. I use “alcoholism” as the example here, but it could be addiction to opioids, cocaine, Xanax, etc. Nar-anon is the self help group from most other drugs. (see below)

As alcoholism/addiction progresses, the family becomes confused, angry, afraid, disillusioned and plain heart-broken as someone they love begins to inexplicably change before their eyes. There is no easy explanation for alcoholism/addiction. It helps, though, to understand as much as possible about the disease and what causes the insane behavior. Family members begin to question themselves, when they don’t understand alcoholism — what have I done? Why is she doing this to me? Does he no longer love me? Does she want to leave because of something I did or didn’t do? The family problems surrounding alcoholism become worse over time unless someone breaks outside the disease to do something different.

Most often family members try everything they can think of to get a loved one to stop drinking, but all the efforts fail. Hopelessness sets in, and many times family members give up and move on. Other times, family members live with the alcoholism for years and years. The following is from NCADD:

Living with addiction can put family members under unusual stress. Normal routines are constantly being interrupted by unexpected or even frightening kinds of experiences that are part of living with alcohol and drug use. What is being said often doesn’t match up with what family members sense, feel beneath the surface or see right in front of their eyes. The alcohol or drug user as well as family members may bend, manipulate and deny reality in their attempt to maintain a family order that they experience as gradually slipping away. The entire system becomes absorbed by a problem that is slowly spinning out of control. Little things become big and big things get minimized as pain is denied and slips out sideways.

Without help, active addiction can totally disrupt family life and cause harmful effects that can last a lifetime.

Support groups such as Al-Anon and Nar-Anon are available for the friends and family of people suffering from addiction (alcohol and drugs, respectively). While these support services are important for making connections with others who may be trying to navigate day-to-day life with addiction in the family, so is seeking  professional therapy. Individual therapy for each family member, not just the addict, is important for the mental health of both the addict’s spouse or partner and children, and meeting with a therapist as a family can help improve communication among family members, rebalance the family dynamic and give family members a safe environment to express their anger, fear and other concerns. Family therapy may also be helpful in preventing the children of addicts from succumbing to the disease themselves.

Helpful Links for Family and Friends of Addicts

  • Al-Anon.org (al-anon.org) For family members of alcoholics.
  • Nar-anon (nar-anon.org) For family members of addicts.
  • Gam-anon (gam-anon.org) For family members of gamblers.
  • Coda.org (coda.org) For co-dependent individuals.
  • Adultchildren.org (adultchildren.org) For adult children of alcoholics and addicts.

People recovering from alcoholism and drug addiction, their families, and their children can and often do achieve optimum levels of health and functioning, but this achievement is best measured in years rather than days, weeks, or months.  In the process of recovery, families are strengthened through increased levels of genuine intimacy and families are better able to cope with life’s challenges.

Am I An Alcoholic?

Am I an alcoholic?This is a question many moderate to heavy drinkers ask themselves at some point. They might not express the concern to others but they’ll ask themselves.  There are tests which are pretty accurate to gather signs and symptoms, to help answer the question – Am I an alcoholic? The SASSI Institute is one of the major providers of screening, research and testing.

If someone has pain in their stomach for a significant period of time, they’ll likely go to a doctor for testing to find out what’s wrong. When someone has frequent headaches, they’ll likely go to a doctor for testing. When someone begins to have poor eyesight, they’ll likely go to a doctor for testing. When someone has problems related to alcohol, they’ll likely say nothing to a doctor, and they’ll likely deny it’s a problem — they’ll blame the consequences of drinking on something else.

We who work in the field of alcoholism treatment are trying to persuade people to think of alcoholism as any other medical condition. Below are some of the questions from the National Council on Alcoholism and Drug Dependence you can ask yourself, then see a professional if you think that alcohol or other drugs (you can easily substitute drug using for drinking in most questions) might be a problem:

Do you try to avoid family or close friends while you are drinking?

Do you drink heavily when you are disappointed, under pressure or have had a quarrel with someone?

Can you handle more alcohol now than when you first started to drink?

Have you ever been unable to remember part of the previous evening, even though your friends say you didn’t pass out?

When drinking with other people, do you try to have a few extra drinks when others won’t know about it?

Do you sometimes feel uncomfortable if alcohol is not available?

Are you more in a hurry to get your first drink of the day than you used to be?

Do you sometimes feel a little guilty about your drinking?

Has a family member or close friend expressed concern or complained about your drinking?

Have you been having more memory blackouts recently?

Do you often want to continue drinking after your friends say they’ve had enough?

Do you usually have a reason for the occasions when you drink heavily?

When you’re sober, do you sometimes regret things you did or said while drinking?

Have you tried switching brands or drinks, or following different plans to control your drinking?

Have you sometimes failed to keep promises you made to yourself about controlling or cutting down on your drinking?

Have you ever had a DWI driving while intoxicated or DUI driving under the influence of alcohol violation, or any other legal problem related to your drinking?

Are you having more financial, work, school, and/or family problems as a result of your drinking?

Has your physician ever advised you to cut down on your drinking?

Do you eat very little or irregularly during the periods when you are drinking?

Do you sometimes have the shakes in the morning and find that it helps to have a little drink, tranquilizer or medication of some kind?

Have you recently noticed that you can’t drink as much as you used to?

Do you sometimes stay drunk for several days at a time?

After periods of drinking do you sometimes see or hear things that aren’t there?

Have you ever gone to anyone for help about your drinking?

Do you ever feel depressed or anxious before, during or after periods of heavy drinking?

Have any of your blood relatives ever had a problem with alcohol?

No Magic Pill For Alcoholism

alcholismpillFrom the time I started working with alcoholics in the early 80s, I’ve heard that science is close to a cure, a pill that might cure alcoholism. None of us really believed that alcoholism would be cured by a simple pill — we intuitively knew that alcoholism is complex. We just didn’t know how complex. Recent research shows that there’s definitely no magic pill for alcoholism on the horizon.

Research from Purdue and Indiana Universities reveals a far more complex system of genetic links to alcoholism. Here’s an excerpt from the Science Daily article referenced above:

By comparing the genomes of rats that drank compulsively with those that abstained, Purdue and Indiana University researchers identified 930 genes associated with alcoholism, indicating that it is a highly complex trait – on par with human height – influenced by many genes and the environment.

The study confirmed genes previously identified as being linked to alcoholism and uncovered new genes and neurological pathways, some of which could be promising targets for treatment. But the sheer number of genes that contribute to the trait suggests pharmaceutical treatments for alcoholism could be difficult to develop, said William Muir, professor of genetics.

“It’s not one gene, one problem,” he said. “This trait is controlled by vast numbers of genes and networks. This probably dashes water on the idea of treating alcoholism with a single pill.”

Maybe one day science will find a cure for alcoholism, but it doesn’t seem likely any time soon. The physical and the psychological factors involved in alcoholism make it a difficult brain disease to treat, but it is treatable. Although the research is revealing even more complexity, the good news is that science has more places to look for innovation in the treatment of alcoholism. Maybe there’s no magic pill, but there might be progress that helps relieve suffering, making it easier for alcoholics to get into long term recovery.

 

Recovery From Opioid Addiction

Opioid recoveryOpioids once referred to synthetic opiates, such as Oxycontin. Opiates referred to drugs derived from opium, such as heroin. Now, most people in the medical field use the term opioids to refer to all opiate-like drugs, natural, synthetic or semi-synthetic. So, when I write opioids, I’m referring to all opiate-like drugs. Suboxone is an opioid, but it’s a different kind of opioid, and it’s a misunderstood opioid. There might be more misinformation disseminated about Suboxone than any other known drug at this point. I’m not familiar with all controversial drugs, so maybe I’ll limit the misinformation regarding Suboxone to within the field of addiction treatment.

Some in the treatment field have a financial incentive to oppose Suboxone, such as in-patient detox facilities, because now opioid addicts are detoxed on an out-patient basis with Suboxone from a doctor’s office. I’m not saying that the detox facilitity personnel consciously oppose Suboxone for purely financial reasons, but the resistance to Suboxone is better understood from this perspective. Otherwise, the resistance makes no sense at all.

For anyone unfamiliar with Suboxone, go here. When it’s said that Suboxone has a significantly lower euphoric effect, it’s an understatement. Ask an opioid addict who’s taking Suboxone if the euphoric effect of Suboxone is anything like heroin or Oxycontin — they’ll laugh. Any “euphoric” effect from Suboxone, after the first few days, is mostly the feeling of relief an addict experiences when they’re no long craving opioids. Suboxone is a partial agonist, which means it doesn’t produce the full opioid effect, but it blocks the receptors so that withdrawal is stopped. Recovering addicts using Suboxone can perform all their daily actions without impairment. Some people are a little tired on Suboxone, but once their dosage is adjusted properly, they are able to work, drive, and do anything else a non-addict would do. Some people, of course, react differently, but that’s true of practically all medicines.

The point is that Suboxone is a great tool when used to stop opioid withdrawal so that an opioid addict can get into treatment and make the necessary changes to recover and  live a drug free. The controversy comes in when some in the treatment field say you shouldn’t treat drug addiction with an addictive drug. First of all there’s a difference between reliance/physical dependence on a drug and addiction. Treatment of chronic pain can cause a person to become reliant or physically dependent on pain killers, but most do not become addicted with the mental obsession and crazed need to continue the drug despite negative consequences. Addiction is associated with compulsion to use a drug, obsession with the drug and the continued use of a drug despite negative consequences. I don’t know of anyone who takes Suboxone for a mood altering effect, or who would continue taking the drug if they were locked up for taking it, or if they lost their family from taking it, or if they were fired from their job for taking it.

Yes, Suboxone can be abused, but, because of the Naloxone, Suboxone is not an easy drug to abuse, nor is it a drug that can be abused long term because of the ceiling effect. If you have to go through a lot of trouble to get a minimal effect, it’s not usually worth it to an addict. Just because a certain treatment can be abused, though, doesn’t mean that the treatment shouldn’t be used — it just needs  monitoring by a competent, knowledgeable physician.

The reason most people take Suboxone long term is because it’s doing no harm and their lives are so much better — they simply don’t want to fix what’s not broken. At NewDay our Medical Director recommends that an opioid addict take Suboxone long enough to get into recovery, then taper off and become drug free. Let’s call it Planned Abstinence. We know a lot more today about the science of addiction, how brain chemistry changes. It’s malpractice to force an addict to suffer withdrawals, and probably relapse, when there’s medicine to relieve withdrawals long enough for the person to get into treatment and plan their path to a drug free recovery. Do doctors and counselors need to a better job helping recovering addicts manage their recovery to a drug-free state? Certainly, but that’s something we can all work on. In the meantime, let’s not allow old ideas to block progress in addiction treatment. And let’s not subconsciously treat recovering addicts who use Suboxone like they aren’t in recovery — they are in recovery.

Heroin, Dope Fiends and Mystics

Heroin, dope fiend and mysticsFor those who get the impression from the news that heroin addiction is a new problem, please understand that heroin has been around for a long, long time, and I mean long. The earliest written history of the opium poppy dates back to the Sumerians in 3300 B.C. The name for the opium poppy is Papaver Somniferum. Arab merchant traders spread the knowledge and use of opium as far as Greece. Of course, it eventually spread across the world — there were medicinal purposes, such as insomnia or pain relief, pleasure purposes and even spiritual purposes as some used it to enhance mystic and religious experiences and rituals.

Around the first century A.D. a leading physician, Dioscorides, wrote about opium crushed and mixed with liquids in an elixir that cured diarrhea, nausea, insomnia and that had an aphrodisiac effect. As Europe established means to travel around the world, the Portuguese discovered the value of opium and traded it along with other goods. The Portuguese introduced the smoking pipe and along with greater access opium became a problem across the far East. Opium’s addictive powers were enhanced by innovative means of using opium and greater access.

Eventually, in the 19th century, scientists learned how to isolate morphine from opium, then later in the century the hypodermic needle was invented, then heroin was discovered by the chemist C.R. Alder Wright in 1874. The smoking pipe was what created the addiction epidemic in the Far East — America and the west were affected by the needle and heroin. Laws were created to deal with opium dens and overdoses and spreading addiction. Campaigns started to demonize heroin. Black market trade exploded. First the Chinese were used as demons who spread heroin, then African-Americans were the demons, then hippie junkies in alleys — now heroin is in middle class and upper class homes.

The efforts to demonize and punish heroin users have failed. Opioids prescribed by Pharmacists and used by people across the socio-economic realm are not much different from heroin — the make-up of the drug, and effects it has on the body and mind are almost identical. Heroin sold on the street can be laced with certain products, and opioids sold by Pharmacies are regulated, but the drugs, heroin, morphine, OxyContin, Percocet, are what they are and the body and mind don’t know the difference. Someone addicted to OxyContin is just as addicted as someone addicted to heroin.

When opioid addicts are cut off by doctors and Pharmacists, they often go to the street for heroin, because the body craves what originated in the opium poppy. Perhaps we should stop demonizing heroin because it’s sold on the streets and look at what creates the demand — addiction. If we can talk reasonably about heroin, and if we remove the old ideas of dope fiends, and remove the romance of the mystic seeking transcendence, and then look at the drug for what it is and what it does, then maybe with science, facts and reality we will make progress reducing the deaths caused by ignorance and fear more so than the drug itself.

 

Alcoholism and Relapse

Alcoholism and relapseAlcoholism is often called a disease of relapse. What pertains to alcoholism and relapse actually pertains to drug addiction and relapse in general, but for simplicity’s sake I’ll write about alcoholism and relapse. Relapse is when an alcoholic has had a period of recovery and then starts drinking again. If an alcoholic has had a period of sobriety and drinks for one or two nights then gets back on track and continues in sobriety, then that’s more of a lapse than a full blown relapse.

It’s not uncommon for alcoholics who are trying to stay sober to “fall off the wagon”, especially in the beginning. Even after months or years of sobriety, alcoholics will return to drinking for different reasons and for varying lengths of time and intensity. If an alcoholic gets into a long term recovery program like AA, the chances of the alcoholic staying sober permanently are much better, but it’s definitely not a sure thing. Some alcoholics return to drinking after many years of sobriety and steady AA attendance. The alcoholic who relapses might drink for a while then return to AA and recovery or they might drink for years before reentering recovery, or they might die drinking.

Alcoholism is a disease that’s difficult to overcome, and even more difficult to understand. Alcoholism is treatable, and relapse is not inevitable or, if it happens, is not the end of the world. Sometimes a person is shamed for returning to drinking – “how could you?” – but it’s a part of the disease. Shaming an alcoholic is never productive. The alcoholic will always have a special relationship to alcohol, even if it seems insane to someone looking from the outside. Science doesn’t have all the answers, but science learns more and more as time goes on. Sometimes it’s as simple as the alcoholic forgetting how bad it was, then after a period time deciding that it wasn’t that bad and that now they can handle it better since they know more about the condition. Sometimes there is no explanation — the alcoholic, when brutally honest, will admit they have no idea why they returned to alcohol.

The best way to deal with alcoholism is to not over-react if relapse happens — remember that most alcoholics die from their condition, so even if recovery is not perfect and relapse free, if an alcoholic is staying sober more than they’re drinking, and if their life has improved significantly, even with the relapses, then that’s better than uninterrupted alcoholism that progressively gets worse and ends in disaster.

Language of Addiction

Language of addictionThe language of addiction is important. When people use certain language to speak about addiction it can perpetuate old ideas that are counterproductive to dealing with addiction. Often you’ll hear someone say with disdain “all he does is get high everyday”. I’ve heard over and over that the addicted person just doesn’t want help so nothing can be done. Often a family member or friend will say that the addicted person is just selfish and doesn’t care about anyone else.

The truth is usually something different. When a person becomes addicted all the “fun” of using is gone and the person is using drugs so they don’t feel the pain of withdrawal. The brain chemistry actually changes so that a person feels as if the drug is a vital part of life. When the person thinks about stopping, the fear of not having the drug is often overwhelming. So, when we say the person is getting “high”, this is not a pleasant high — it’s just an attempt to feel normal because without the drug the physical pain and mental anguish are excruciating. The idea that the addict is getting high, partying, living it up, having a ball, doesn’t accurately describe the reality of the addict.

Once we realize that the addict is using because the pain of not using is too much to bear, then anger and condemnation toward the addict don’t make much sense. The addict is not consciously choosing to use drugs for selfish enjoyment — the addict uses drugs because to the addict it’s a matter of survival.

Not all addiction has reached this stage. Addiction becomes progressively worse. The signs and symptoms become more obvious over time. It could be that a person is selfish and lives a party life without thought of how it affects others, but all too often constant, obsessive drinking and other use is a sign of addiction. In order to deal with the problem this progression has to be understand, and the correct language of addiction must be used to describe the reality. If old ideas persist that the addict is simply choosing a selfish lifestyle of partying and getting high, then it’s difficult to reach the empathy necessary to effectively recognize and deal with the problem.