Realistic Addiction Recovery

Addiction recoveryThere’s so much negative news about active addiction and its consequences it helps to balance that out with stories of recovery. Most people don’t hear about addicts in recovery because it’s not news worthy. I’m always careful when talking about addiction recovery — I try to talk about realistic addiction recovery. Too many times, even when someone hears a story about addiction recovery it’s either too dramatic, too flowery or just too unrealistic. The person who hears these stories doesn’t believe them because they appear to be sensationalized — too many stories of wild escapades and not enough description of tortured mental and emotional states. There’s no need to dramatize stories of recovery. The point of the story is to show recovery is possible, although difficult and not always a neat story of tragedy to triumph.

All recovery stories have similarities, yet they’re all unique. Some young people used drugs only a short period of time, but it was enough for them to stop and choose a drug-free life. Some stories are about decades of drinking alcohol, opiate dependence or ups and downs of addictive cocaine use. Simply describing the use, the consequences and the eventually realization of addiction is enough to get a message across. I find it helpful, though, if a person describes their mental states at different stages of addiction.

To use alcoholism as an example, in the beginning a person doesn’t realize they’re susceptible to alcoholism and are in the early stages of alcoholism. No one wants to be an alcoholic — most people who start drinking alcohol just want to be like everyone else — drink and have a little fun, companionship and relaxation. If the drinking becomes heavier than most, it’s easy to justify it by saying you have a high tolerance — it’s even a bragging right to show you can hold your booze. Then when consequences happen, the advancing alcoholic blames stress, or tragic early events, or an overbearing spouse, or bad luck, or whatever. By this time alcohol is something that’s very important to the alcoholic. The alcoholic senses something’s wrong but tells himself he can handle it, that he’ll cut back. 

Then comes the steady decline of breaking promises, shame, anger at losing control, fear of the chaos and regret for the broken relationships, free-floating anxiety that something awful is happening and not knowing what it is or how it will end. These are mental/emotional states that addicts go through in one form or another. This isn’t drama, it’s a realistic decline, a chronic brain disease that takes over a person’s life. It kills many addicts. Most addicts die a premature death due their addiction. The realistic addiction story is a story of hope — it’s a message that the addict doesn’t have to live a tortured life and die prematurely. Recovery can happen.

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.

In the next few days, 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.

 

The Joy of Recovery From Addiction

The Joy of recovery from addiction

Celebrating Recovery

I find that most people are uncomfortable talking about addiction, addiction treatment or addiction recovery. The word addiction is loaded with negatives and stigma still remains. Some people have an image of a skid row “wino”, while others envision a drug addict using a needle in a run down house, and still others might envision the crazed cocaine addict with a crack pipe. Addiction is often perceived by  as a moral failing, or an unfortunate condition caused by lack of will power, or a purposeful consequence of too much irresponsible partying.

I’ve heard many times when discussing addiction and addiction treatment with someone who’s not very familiar with the subject that treatment doesn’t work –usually based on someone they know who went through treatment and started drinking or using drugs again. Even when some acknowledge that addicts stay abstinent in programs like Alcoholics Anonymous, they see them as pitiful characters huddled together trying to make it through the day without going back to their old lifestyle.

Although more and more people are learning about addiction and recovery from addiction, there’s still a long way to go. After working in the addiction treatment field for 16 years, I’m encouraged more now than ever before that addiction treatment and recovery will become widely understood as inspirational and life changing. I’ve had the opportunity to witness thousands of addicts receive treatment and transform their lives in recovery. Today I celebrate recovery. I never feel sorry for the addict who comes into treatment — addicts don’t need sympathy, they need empathy and understanding and encouragement and education and a helping hand. If someone just can’t get past their judgements regarding addiction, they can at least not do any harm. I’m a witness that treatment works and recovery is real.

Alcoholics Anonymous has what they call Open Meetings the general public can attend — it’s usually a speaker meeting where someone in recovery tells their story. If you want to witness recovery first hand, go to an open meeting and listen with an open mind. If it doesn’t change you, go to a few more — you’ll eventually understand.

Symptoms of addiction

signs and symptomsOne question I often get is how does a person know if they’re addicted, especially in the early stages of addiction. In the beginning, the symptoms of addiction are behavioral and psychological more than physical. When a person begins to drink or do drugs at inappropriate times, or when a person sets out to drink just a few drinks, or take just a little cocaine, then winds up drinking more or doing more drugs than they intended, it might be a sign of early addiction. Since it’s easier to write about one drug, we’ll use addiction to alcohol as the example.

Alcoholism has been called controlled and uncontrolled drinking. One would think that if a person can control their drinking they don’t have a problem, but this not necessarily true. Social drinkers don’t “control” their drinking in the real sense of control. The social drinker can take it or leave. Just like I don’t control drinking orange juice — sometimes I’ll drink orange juice and sometimes I won’t — orange juice is not something I obsess over and actively attempt to control. The alcoholic begins to lose control at times in the early stages, so they begin exerting great effort to control the amounts they drink. The early stage alcoholic can control their drinking at times, but then at other times they lose control and drink way more than they intended.

Another sign of early stage alcoholism is tolerance. Social drinkers don’t usually build up a tolerance, but alcoholics build up a tolerance to alcohol and can out-drink most people. The tolerance reduces in late stage alcoholism when the liver no longer functions properly, but, in the beginning, the early to middle stage alcoholic might brag that he/she can drink a lot of alcohol without getting drunk. This is not an accomplishment — it’s a sign of alcoholism and it can do great damage to the body.

In the later stages of addiction, there’s withdrawal when the person stops drinking, and these withdrawals become more severe as time goes on, including Delirium Tremens, what they call DTs, and seizures. At this late stage of alcoholism there’s little doubt, but early stage alcoholism is difficult to detect. If a person is showing signs and symptoms of drug addiction, they should speak with a professional counselor who specializes in addiction treatment. Untreated addiction is dangerous and leads to very bad, often fatal, consequences — it’s not something a person wants to ignore or deny. There should be no shame in seeking help — addiction happens to about 1 in 10 who drink or do other potentially addictive drugs. If you’re worried about your, or someone else’s, drinking or drug use, because you’ve noticed the symptoms of addiction, ask for help.

Alcohol, other drugs and society

drug addiction

A drug is a drug

In reference to alcohol, other drugs and society, one of the biggest barriers in recovery from addiction is societal attitudes and beliefs concerning the use of alcohol or other drugs. Alcohol is the nation’s socially acceptable drug, yet most people have no idea that, first, alcohol is a drug. When most people think about drugs, they think about pot, cocaine, prescription drugs, heroin, etc., but not alcohol. Alcohol is a drug — it’s just a socially accepted drug. We could have accepted some other drug as our drug of choice to legally sell, but alcohol was the drug chosen. The stigma associated with the use of other, illegal drugs prevents a lot of people from getting help, but a social/legal construct doesn’t have anything to do with how a drug interacts with the brain and body — drug addiction is a health concern first and foremost. It helps to understand the facts about all drugs, especially alcohol. Legal concerns should be secondary. Value judgments made about the use of other drugs are suspect in light of facts about alcohol and the damage it’s done to society.

Advertising dresses up this drug, alcohol, in respectable clothing, so that it’s an escape to the beach, a social lubricant, a romance enhancer, a sports-watching aid, and all that, but alcohol is still a mood-altering drug to which 10% of the people who drink alcohol become addicted. Even health professionals who know alcohol is a depressant drug talk about alcohol as if it’s separate from other drugs — they will say “alcohol or drugs” rather than “alcohol and other drugs”. Ideas about “good” alcohol and “bad” drugs are ingrained in society, so much so that it’s difficult to have an objective discussion. A drug is a drug, and alcohol does more damage to society than all other drugs put together. Making a decision to drink alcohol when one comes of age shouldn’t be an easy, automatic decision. There’s a lot to be said for living a drug free life. At least a person needs to know the facts before making such a big decision.

Many people are irritated with talk about alcohol and the damage it does — they’re likely protecting one of the few pleasures they have left. Most people drink responsibly and have no problem with alcohol, but that doesn’t mean we shouldn’t know the facts about alcohol and to put its use as compared to other drugs in perspective. This is from NCADD.

To get a better understanding of how devastating alcoholism is in our country, here are a few figures from the Centers for Disease Control and Prevention (CDC):

  • 88,000 deaths are annually attributed to excessive alcohol use
  • Alcoholism is the 3rd leading lifestyle-related cause of death in the nation
  • Excessive alcohol use is responsible for 2.5 million years of potential life lost (YPLL) annually, or an average of about 30 years of potential life lost for each death
  • Up to 40% of all hospital beds in the United States (except for those being used by maternity and intensive care patients) are being used to treat health conditions that are related to alcohol consumption

Over time, excessive alcohol use, both in the form of heavy drinking or binge drinking, can lead to numerous health problems, chronic diseases, neurological impairments and social problems, including but not limited to:

  • Dementia, stroke and neuropathy
  • Cardiovascular problems, including myocardial infarction, cardiomyopathy, atrial fibrillation and hypertension
  • Psychiatric problems, including depression, anxiety, and suicide
  • Social problems, including unemployment, lost productivity, family problems, violence including child maltreatment, fights and homicide
  • Unintentional injuries, such as motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.
  • Increased risk for many kinds of cancers, including liver, mouth, throat, larynx (voice box) and esophagus
  • Liver diseases, including fatty liver, alcoholic hepatitis, cirrhosis
  • Gastrointestinal problems, including pancreatitis and gastritis
  • Alcohol abuse or dependence – alcoholism.

Alcoholism has little to do with what kind of alcohol one drinks, how long one has been drinking, or even exactly how much alcohol one consumes.  But it has a great deal to do with a person’s uncontrollable need for alcohol.  Most alcoholics can’t just “use a little willpower” to stop drinking.  The alcoholic is frequently in the grip of a powerful craving for alcohol, a need that can feel as strong as the need for food or water.  While some people are able to recover without help, the majority of alcoholics need outside assistance to recover from their disease.  Yet, with support and treatment, many are able to stop drinking and reclaim their lives.

These are just facts, and the social drinker need not worry — however, given the severity of alcoholism, everyone should know the true nature of the drug alcohol.

People freely choose to drink – Part II

addiction to alcohol

Consequences of alcoholism

This is Part II of Old Ideas About Addiction.

How can addiction be a brain disease when people freely choose to drink or do drugs? Doesn’t this relieve the addict of all responsibility? This is a common rebuttal when discussing addiction. If we go down this road, we’ll find that many diseases are the result of people’s behaviors, such as smoking, eating habits, sexual behavior, lack of exercise, etc. Let’s just discuss drinking and addiction to alcohol for simplicity’s sake, but it can be true of opiate painkillers, nicotine, caffeine, benzodiazepines (nerve pills), and other drugs to which people can become addicted.

People start drinking alcohol for many reasons — socializing, experimentation, relaxing after work, peer pressure in high school and college, or just because so many other people drink and the person wants to fit in, especially with work associates. Most people can look back at their first drink of an alcoholic beverage and it was probably innocent and harmless. You might get sick in the beginning, but you learn to drink, and most people find they can take or leave alcohol.

No one sets out to be an alcoholic. I don’t know of anyone who started drinking to become an alcoholic. It’s definitely an old idea to think that alcoholics enjoy their drinking in the middle and late stages — the drinking at some point becomes a necessity in their mind that keeps them from falling apart and going into serious withdrawals. This is not fun — it’s painful and soul-crushing survival. Just because you see someone who’s an alcoholic while they’re drinking, appearing drunk and having a good old time, this is a snapshot and I can assure you that there are consequences you don’t see — physical complications, relationship problems and states of mind no one wants to experience.

Research has shown that for some people, when they start drinking, they develop a different relationship toward alcohol. It can happen over months or over years or decades, but the person eventually loses control over how much they drink. The alcoholic in the early stages sets out at times to drink a few drinks then go home but stays at the bar until closing. When asked why, the alcoholic might give a lame excuse, but when the alcoholic are forced to be honest, they’ll say they don’t why — they felt compelled to have one more, then one more, then lost all control until they were drunk.

This type of drinking doesn’t happen every time in the early stage of alcoholism, but the alcoholic can never tell when it will happen, and it happens more often as time goes by. The alcoholic will over-drink at parties and embarrass herself and anyone with her. The alcoholic will find the compulsion to drink getting worse over time. There are many signs and symptoms and that develop over time, but the point is that the alcoholic is not choosing to experience these consequences or this progression of insane drinking — only someone deranged would want to live this way.

Why doesn’t the alcoholic just stop, if the drinking is so painful? Well, we’ll talk about that in the next post.

Old Ideas About Addiction – Part I

Addiction as brain disease

Addiction

There are stubborn ideas about addiction that persist in spite of decades of knowledge and experience that contradict these old ideas. Many people believe addiction is a moral weakness, a failure of will power. There’s still the idea among many mental health therapists that addiction is the result of some underlying psychological disorder. Let’s address this one first. Addiction might cause psychological problems, and psychological disorders might co-exist with addiction, and addiction might make a co-existing psychological disorder worse, but there’s no evidence that addiction is caused by an underlying psychological disorder. This idea has been that a person was, say, neglected as a child, then grew up with low self esteem that became, say, depression or anxiety — the person starting drinking alcohol to deal with the low self esteem and depression or anxiety and this caused the person to become an alcoholic.

This is from WebMD:

Drug addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the drug addict and those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person’s self-control and ability to make sound decisions, and at the same time create an intense impulse to take drugs.

Why is it that people from healthy, loving environments become addicted to alcohol or some other drug? Why is it that people with no history of psychological disorders become addicted? There’s a theory going around now that people who live in poverty or dire situations like war with very few choices to pursue happiness and love become addicts because of their living conditions, and that this is likely the cause of addiction — the theory states that “addicts” don’t need abstinence — they need love and a better life. How does this explain the millions of addicts who come from middle class, upper middle class and very rich families and living conditions?

The truth is that those who become addicted to alcohol and other drugs can be well-adjusted prior to drinking and using drugs — they can be from good, caring families– they can be moral — they can be spiritually grounded — they can be rich, financially comfortable or poor — they can be any combination of things. This is all before the addiction. The course of addiction can change a person, of course. The moral person can act immorally as the addiction advances and the impaired judgment has its affect — the rich person can make bad choices during addiction and lose money — the person who becomes addicted can become very sick mentally.

When I was working as a counselor in an inpatient treatment facility, we treated several Catholic priests who started out drinking alcohol socially like a lot of Catholic priests — but these priests I counseled became alcoholics. I heard their life stories and there was nothing unusual about their lives before becoming alcoholics. They had the same experiences of growing up as most people — no terrible trauma — no sexual abuse — no overbearing mother or violent father. They started drinking alcohol and it changed their brain chemistry to the point they craved alcohol and got lost in the craziness of alcoholism. The point is that it’s illogical to say psychological problems cause addiction. There’s a big difference between cause and effect. Science doesn’t yet know the complete cause of addiction, but the more science learns about brain chemistry, the closer we get to the cause, or causes.

I’ll write several parts to this, because there are many old ideas that need to be addressed.

Holiday Season and Addiction

holidaysandaddictionThe Holidays are difficult for many in recovery. In Savannah, the local AA clubhouse has all day activities for people who feel uncomfortable and need support. This doesn’t mean that all recovering addicts are in need of extra support around the Holidays. Most people in recovery are comfortable doing most anything other people do — they just do it without drinking or doing other drugs. Early recovery is the most difficult time for the pressures of the Holiday Season. Here are some suggestions to deal with the Holidays.

Addiction and Denial

If you know anything about addiction problems, then you know denial is a big part of the defensive system built up over years by the individual with a problem. Denial is also often present among family members and friends of the addicted individual.

Here’s an article that’s very helpful for those who want to understand denial more fully.