Neuroplasticity and Addiction Treatment: Part One

Neuroplasticity and addiction treatmentI firmly believe that the relationship discovered going forward between neuroplasticity and addiction treatment will greatly improve recovery outcomes. With addiction, although it might seem strange to someone who doesn’t understand addiction, the particular drug used is not so important as what happens to the brain when an addictive drug is taken by someone with a predisposition to addiction. The particular drug of choice will be important to the person in recovery because of environmental, social and emotional triggers that remind the recovering addict of a place, a smell, a friend or a feeling associated with their main drug of choice – understanding these triggers is vital to relapse prevention, but, otherwise, the brain reacts pretty much the same, in relation to addiction, to all addictive drugs. The neuro-chemical actions in the brain are different from one drug to another – however, the neural-pathways created by repetitive drug use are what make recovery so difficult. Because this is not a simple subject, I’ll write this in several parts.

Let’s start from when neural pathways are strengthened and make drugs seem necessary and good to the addict. The addict consumes a drug, dopamine flows, the midbrain remembers the quick sense of euphoria or well-being, and neural pathways are strengthened, repeat and repeat and so on. In most people who’re social drinkers, their brains never change to the point that craving a drug overwhelms reason and judgment. For the addict, brain chemicals make changes that create tolerance and the irrational craving for more and more of the drug. This vicious cycle continues until there’s treatment and a reversal of the process.

People on the outside who witness an addict go into treatment and come out with the drug completely out of his/her system are mystified when the person returns to the drug shortly after treatment. It’s usually because he/she stops doing anything further to promote recovery. After years of strengthening neural pathways that tell the brain a drug is good and necessary, these pathways are too strong to overcome with just a few weeks of treatment. In treatment an addict should learn that recovery is a long-term process. It takes a while to strengthen the neural pathways that tell the brain the drug is deadly, and that recovery is healthy and life enhancing.

If you’ve ever had to change your ideas about something that’s deeply ingrained in your brain, that you’ve reinforced for years, like eating fried food, or a long-term love relationship that you discover, after decades, has gone terribly awry,  you understand how hard it is to change the brain to see something you enjoyed immensely, loved or craved as harmful and something that you must resist. Now, take that understanding and multiply it and you’ll get an inkling of an understanding how hard it is to stay away from a drug that captured the body and mind for years. For years the addict could take the drug and, quickly, the strong feeling of euphoria or well-being was there on demand — the addict’s brain stored the powerful memory of immediate satisfaction deep in the midbrain and associated this memory with people, places and things that trigger the desire to use the drug — now the drug has turned on the person, but the brain still wants the relief, quickly, with power and consistency. It takes awhile to change this in the brain. The good news is that the brain can change and recovery is possible.

Tomorrow, I’ll write more in detail about neuroplasticity and addiction treatment how the brain changes in recovery according to those doing research in this area.

 

Alcoholism and Anxiety Disorder

Alcoholism and anxiety disorderAlcoholism and anxiety disorder often go hand in hand. There are several reasons — one being that alcoholism and anxiety disorder can coexist. This means that a person has two diagnoses – alcohol use disorder and anxiety disorder. In this case of co-occurrence, alcoholism and anxiety disorder are both treated as separate conditions, although as I’ll write about below, they affect one another. If a person is an alcoholic with an anxiety disorder, the drinking makes the anxiety worse, although the person thinks the alcohol is helping the anxiety– it becomes a vicious cycle.

Most people get confused with a chicken/egg question — which comes first? Does anxiety disorder cause alcoholism? Does alcoholism cause anxiety disorder? There’s no evidence that anxiety causes alcoholism, but anxiety can complicate alcoholism. It’s long been known that anxiety causes some people to abuse alcohol, but there’s a difference between abusing alcohol and alcoholism. In the case of the person with an anxiety disorder who abuses alcohol in a misguided attempt to self medicate, if the person receives professional help to treat the anxiety, the person will likely stop abusing alcohol. In the case of co-occurring alcoholism and anxiety disorder, if the person treats the anxiety but not the alcoholism, the alcoholism will continue, and vice versa.

There’s some research showing that alcoholism might cause anxiety disorder, that both conditions relate to the same area of the brain that’s changed by alcoholism.  It becomes confusing, but understanding each condition and how they relate to one another is important when determining courses of action to deal with either or both. Drinking to alleviate social anxiety, panic attacks, or generalized anxiety only complicates the anxiety, and can make the anxiety worse — also, as mentioned above, if a person suffers from both alcoholism and anxiety disorder, treating one but not the other will not solve the problem.

When dealing with alcoholism and anxiety disorder it’s important to know that recovery won’t be easy, but when recovery does happen, very good things happen.

Opioids and Doctors

Doctors and OpioidsIt’s easy to blame doctors for the rise in opioid addiction, but this isn’t fair to doctors. The issue of opioids and doctors is tricky. Patients with chronic pain require pain medication, and the best pain medication is usually some type of opioid – opioids can be addictive. Doctors share some of the responsibility, though, especially if they’re “high intensity” prescribers. A recent study shows that patients in need of pain management are 30% more likely to become long term opioid users if they’re patients of high intensity prescribers. Below is an excerpt from a NYT’s article on the study:

Over all, researchers estimated that out of every 48 patients who were sent home with a prescription, one would end up using opioids long-term, which researchers defined as at least 180 days of medication over a year. Chronic opioid use, particularly in older people, can contribute to spiraling problems: constipation, confusion, falls and addiction.

 
I believe if doctors received more training on addiction in medical school, opioid addiction would significantly decrease. I should stop here and make a distinction between physical dependence on opioids and addiction to opioids. Many long term opioid users will likely develop a physical dependence, but addiction is more than just physical dependence. For those predisposed to addiction, using opioids will become a major problem — addiction being a chronic brain disease characterized by tolerance and continued, obsessive use despite negative consequences. Most pain patients who become physically dependent on opioids  don’t develop the obsession associated with addiction – they’ll detox off the medicine when it’s no longer medically useful. The addict, however, will crave the opioids even after they’re no longer needed — and the addict will use higher and higher amounts of the opioids. Even if the patient’s detoxed in a hospital, unless there’s some form of addiction treatment, the person will likely return to opioids.
 
With a better understanding of addiction, doctors can recognize more quickly the signs and symptoms of addiction and refer to treatment. Doctors can also use alternative means of pain management for patients who have a history of addiction. There’s evidence that Suboxone is good for long term pain management, and it’s also a replacement treatment for opioid addiction. Sometimes opioids are the best treatment for pain, but sometimes opioids cause long term damage. If government begins regulating the opioid problem, that might not be the best solution — it might be best if the medical field regulates itself.

 

Sober Community

sober communityIn almost every town, if not in every town, there’s a sober community made up of people in recovery. Most often it’s people who attend Alcoholics Anonymous, or a church group that provides a sober community for recovering addicts, but sometimes it’s just a group of people who know one another and are all living the sober lifestyle. When a person chooses abstinence from alcohol and other drugs, their lifestyle doesn’t have to change drastically, but going to bars sober is not the same if everyone around you is high.

If, though, you have a network of friends who’ve also chosen abstinence, then going to a nightclub to dance is just as fun, if not more fun. Among people who drink and do drugs, there’s usually the idea that fun’s associated with some type of mood-altering drug, as if we don’t have what it takes naturally to have fun. It’s a very sad statement that human beings require an artificial stimulus to have fun. Not only is it sad, it’s not true.

In larger cities, there are recovery clubs, places where a community of people meet who’re living the sober and clean life. There’s also online sober communities. It’s not a crutch — it’s a chosen association. I often have people who can drink socially with no problem talk as if sobriety is an imposed burden — they believe that living sober is difficult, and that I must miss it and struggle to stay away from it. When I stopped drinking years ago, I thought people who didn’t drink or do some kind of drug were weird, a different kind of animal. I also thought people who had a problem and quit were always tempted. What I found in the sober community were people just like me. They chose to live drug-free. For the most part, the people I met in recovery were well-adjusted, happy and a little wiser as a result of overcoming something that had taken their freedom. They didn’t want to drink or use some other drug — they were satisfied and fulfilled in sobriety.

Freedom was one thing I noticed right away. I was inspired by the idea I didn’t need alcohol. I didn’t have to arrange things around my drinking — I wasn’t spending money I didn’t intend to spend (money I needed to pay bills) — I wasn’t paying legal costs for drinking related offenses — I wasn’t suffering the physical complications of heavy drinking and poor nutrition — I wasn’t letting people down by breaking promises or missing important occasions — I wasn’t expending energy lying, keeping up with the lies and despising myself for the dishonesty.

The sober community is a free community — Some of the best people and best friends I’ve met have been those who had a drug problem and are now living free from alcohol and all other drugs. It doesn’t mean I have no friends or associates who drink — I do, but I don’t have the same mindset as those who still believe that in order to have fun, relax and socialize you have to drink alcohol or use some other mood altering drug. I’m very grateful for this.

When Recovery Becomes Real

When recovery becomes realAt NewDay Counseling we have a slogan – With Each New Day, Recovery Is Possible – that sounds a little corny, but the truth behind this corny slogan is powerful and real. When a person understands the “new day” concept, this is when recovery becomes real.  I’ve witnessed thousands of patients/clients through the years go through the treatment process and embrace recovery from addiction. Recovery is more than getting the drug out of the body — it’s a transformation. Each person’s recovery is a little different, but there are common factors, too.

Addiction can be like a long, continuous nightmare. There’s a newness to recovery that’s like the start of a new day. The difference is that the things which happen during addiction are all too real. The nightmarish quality of addiction begins to dissipate only when the person accepts reality and becomes willing to change. No one can tell a person how to change. Each person recovering from addiction chooses their own path. Many use support programs like Alcoholics Anonymous or Narcotics Anonymous, and some choose their church community, while other might utilize a network of family and friends.

If you’ve ever had a bad day, or a string of bad days, and it seems like nothing will change, but then wake to a beautiful “new day” that inspires hope, then you understand a little about recovery from addiction. Hope is powerful when you’ve suffered from the emptiness and anxiety of hopelessness. The “new day” experience is a deeply human experience — it’s the realization that things can change, that life doesn’t have to stay the same.

Recovery becomes real when the recovering addict becomes honest, open and willing. Of course, nothing changes dramatically once and for all with no further effort. The “new day” experience is the acceptance that one “new day” at a time, a person can stop using alcohol or other drugs, repair the past as best possible and achieve goals. As I’ve said, I’ve witnessed thousands of people recover — it’s real, and when recovery becomes real, things change — there’s hope.

From Addiction to Self Esteem

From Addiction to self esteemNathaniel Branden once described self esteem as the reputation you have with yourself. If you know someone who frequently lies to you, you usually think less of the person. If someone takes something from you by deceit, you don’t trust them. If someone’s always negative, you don’t like being around them. What if that “someone” is you? After a while you think less of yourself, you don’t trust yourself, you don’t even like your own company. When you don’t feel comfortable in your own skin, something’s terribly wrong. Moving from addiction to self esteem takes action, persistence, understanding and time.

A person living with addiction begins lying to defend against the consequences of constant drug use. People who become addicted sometimes steal, and this is not just common theft — executives in large companies might skim from their employer to cover the high cost of addiction. Addiction almost always negatively affects self esteem. The addicted person becomes undependable, and the idea of being a screw-up seeps in and is reinforced over and over.

I’ve heard clients in treatment say they don’t like themselves, don’t trust themselves and many don’t believe they can change. If a person’s trying to recover from addiction and doesn’t improve their self-esteem, they might grow restless and discontent in their own company because of bad memories and their poor self image. Recovery has a lot to do with forgiving ourselves for the past and making a plan to do differently in the future, changing things we messed up, if possible.

Once the recovering person begins taking action, changing the way they relate to others, making an effort to be honest, apologizing immediately for mistakes, repairing the past, but realizing no one is perfect, things begin to change – the person begins to realize they can achieve goals — they can follow through — they can become dependable and trustworthy. Self esteem improves recovery and makes a person want to continue in the journey from addiction to self esteem as confidence and self-respect grow.

Pharmacology and Alcoholism

Pharmacology and alcoholismPharmacology’s making it easier to stop drinking. As anyone familiar with alcoholism knows, getting alcohol out of the body is only the bare beginning. The reason alcoholics often return to drinking is due to the psychological obsession with alcohol, the ongoing craving for alcohol even after the body has been detoxified.

The alcoholic will crave alcohol long after detox, and this is why support groups like Alcoholics Anonymous are important. It also helps when the recovering alcoholic has support from family and friends, from a physician, and, often, from ongoing counseling. If the recovering alcoholic starts nutrition and exercise plans, both will help the recovering person get past the mental obsession. After a few months, the brain will heal and the recovering alcoholic will not longer crave alcohol — it could happen even earlier, as we’re all different.

Now, pharmacology might offer one more tool to the recovering alcoholic to assist in that early, difficult part of recovery. It’s a medicine that’s usually prescribed for asthma. Here is an excerpt from Medical Daily:

Giving up alcohol isn’t the hardest part of overcoming alcoholism — the subsequent cravings are what lead most to relapse. A new study from UCLA may have a way to better address these cravings. According to the research, a drug commonly used in Japan to treat asthma also has the unexpected side effect of quelling a desire for alcohol by reducing the pleasurable effects of drinking. The findings could one day make the drug a candidate for use in alcohol abuse treatments.

According to a study now published online in  Neuropsychopharmacology, the drug ibudilast significantly lowers user’s cravings for alcohol and helps to improve their mood when confronted with alcohol which they are not allowed to drink. In addition, the drug seems to alleviate user’s depression, a condition very common in heavy drinkers.

Recovering alcoholics need all the help they can get. Hopefully, this asthma medicine can be turned into an approved medicine for the treatment of alcoholism. It’s hard to describe the obsession with alcohol that tortures the alcoholic mind — it confounds loved ones, friends, employers and even medical professionals. It seems insane for a person to crave something that’s killing them, but this is the nature of alcoholism — now, hopefully, there’s more help to deal with this chronic brain disease.

Heroin Laced With Fentanyl

Heroin laced with FentanylWhile heroin is a commonly known drug, you might’ve heard lately about heroin laced with Fentanyl, yet not know much or anything about Fentanyl. Here is a description:

Fentanyl is a synthetic opioid, meaning it is made in a laboratory but acts on the same receptors in the brain that painkillers, like oxycodone or morphine, and heroin, do. Fentanyl, however, is far more powerful. It’s 50-100 times stronger than heroin or morphine, meaning even a small dosage can be deadly.

Fentanyl can be produced in illegal laboratories, which means, for the foreseeable future, availability won’t decrease through government regulation. This synthetic opioid is very, very powerful, so it makes a dangerous drug like heroin much more dangerous and deadly. It only takes a small amount of Fentanyl to increase the effects of heroin and cause overdose. Even scarier, some drug dealers are selling a combination of heroin, Fentanyl and cocaine.

Those who buy heroin on the street and start using heroin laced with Fentanyl are at a much higher risk of overdose and death — the drug user becomes dependent on how much Fentanyl is used, their tolerance and other physical factors that in combination can create overdose. It sounds perverted, but a drug dealer might increase business if someone overdoses and dies from heroin laced with Fentanyl, because, on the street, the word of a powerful heroin/Fentanyl mix will likely create a buzz of interest as users seek greater highs. In the experienced user’s mind, they’ll think they can handle the more powerful mixture and that those who died were neophytes.

As congress begins decreasing the amounts of opioids doctors can prescribe, a certain number of patients who’ve become addicted to opioids, but need the drug for management of chronic pain, will seek drugs from alternative sources – if they begin buying synthetic opioids on the black market, this will increase the number of deaths, not lower the number of deaths. I don’t think drug addiction will respond to regulation — it can be treated, though. Heroin laced with Fentanyl is nothing to play with. The entire opiate/opioid addiction epidemic will only get worse until society decides to take action to find fundamental solutions.

The same man will drink again

recovery requires changeThis is an addition to yesterday’s post. To clarify, in addiction treatment when we deal with the social and psychological consequences of addiction, we’re not trying to establish our preference for value judgements. We’re looking at coping skills and encouraging the clients to re-evaluate how they see and react to people, places and things.

For most people, not just those with an addiction problem, life can get hectic. It’s difficult to find the time to stop the merry-go-round, look inward to assess our emotions and state of mind, and to look outward to evaluate our relationships. When I say relationships, I mean romantic relations, friendships, relationships with co-workers or fellow student — all relationships.

In treatment, the client has time and opportunity to explore how they’ve coped with problems, determine how well the coping mechanisms have worked, and look at new ways to solve problems or just accept reality. Most of us develop coping skills at an early age and never stop to re-evaluate how well we’re coping with life presently. Some of our old ideas about people, places and things may not sync with our present reality. A life well lived, according to all the great thinkers on the subject, is a life honestly examined and improved as time goes on. Socrates said – Know thyself.

For the person recovering from years of chaotic addiction, these exercises in examination and improvement are not just nice self-improvements exercises — they’re very important to recovery. The Chinese have an old saying — The same man will drink again. This means for a person who has a drinking problem and stops drinking, if the person doesn’t change he/she will drink again.

We see it all the time in treatment – a person goes through treatment, becomes educated about addiction, is encouraged to re-evaluate their life and start a program recovery management, then they leave treatment and make no changes at all — soon they’re calling saying they started drinking or using opiates again and don’t know what happened. What happened is the same man/woman drank again.

Easier, Softer Way

easier, softer wayIn Chapter 5 of the book Alcoholics Anonymous there’s a warning about alcoholics seeking an easier, softer way to deal with alcoholism. Often someone suffering from addiction will seek help through a friend, a pastor, their doctor, a family member or maybe an individual therapist. I won’t say that any of these forms of help can’t work. I do know that addiction treatment is usually required if there’s to be much lasting change at all. The tough decisions and commitment necessary to deal with a medical condition as powerful as addiction are not easy. Some people deal with the problem through non-professional methods, but most people who suffer from addiction require some level of specialized addiction treatment.

The mistake most people make when trying to help someone who’s addicted to alcohol or some other drug is to immediately assign psychological reasons for the constant drinking or use of drugs: She had a bad childhood – He lost his wife – She has never fit in. In addiction treatment, we deal with the medical condition first. Addiction is a medical condition, a chronic brain disease, with a strong genetic influence that’s complicated by social and psychological factors.

Treatment begins by stabilizing the medical condition — detoxification, medical assessment, and understanding the chronic brain disease. Medication might be needed for detox, but the ideal course of action is to become drug free as soon as possible. When dealing with opiate addiction, Suboxone might be prescribed for the early period of treatment, long enough for the client to get into treatment and establish a support network. If the client can’t detox on an outpatient basis, inpatient detox will be recommended, and perhaps a few weeks of inpatient treatment.

Once there’s medical stabilization and we develop a treatment plan, then we begin dealing with the social and psychological aspects of addiction. Sometimes, a person is depressed and anxious in the beginning, but this is common for someone who’s been living a life torn apart by addiction. In some cases the depression and anxiety might have preceded the addiction, so that these co-occurring conditions are addressed and treated along with addiction. Depression and anxiety are not known to cause addiction, but they can co-exist with addiction, and addiction almost always makes co-existing conditions worse. So, when someone says that they’re drinking because they’re depressed, they don’t understand that alcohol is a depressant (although the first few drinks might have a stimulant effect) and makes depression worse over the long run, not better.

The life of addiction creates or masks problems that are dealt with if a person is to have the best chance at recovery. If a person stops drinking and nothing else changes, they’re usually filled with chaotic emotions, guilt, remorse, anxiety, depression, resentments, etc. These lingering consequences of addiction can overwhelm a person, making them restless and discontent, so much so they that go back to their drug of choice. If the person resolves the social and psychological problems, though, this doesn’t mean that he/she can return to social drinking or recreational drug use. Once biological predisposition to addiction is established, active addiction will recur once the person starts drinking or using again. Addiction is a chronic brain disease and so far there’s no known cure. If the person remains abstinent, however, they can lead a normal, fulfilling life. It’s not just people with addiction who are filled with chaotic emotions and psychological scars, but the person recovering from addiction has a chance and a need to deal with these problems and gain peace of mind — who wouldn’t benefit from taking time out to assess our emotions and psychological state?

So, if a person with an addiction problem tries to deal with the symptoms of addiction with symptomatic solutions, they might miss the fundamental nature of addiction which has to do with how the drug affects the brain. Many people who’re searching to find help, want help that will allow them to one day drink and use drugs socially with no consequences — the easier, softer way actually becomes very hard and painful. Ironically, (paradoxically?) it turns out that, for the addict, the easier, softer way is abstinence and recovery management.