A Wake-Up Call about Relapse

Cory Monteith, Glee actor, was found dead in his hotel room in Vancouver recently from a heroin and alcohol overdose. He was frank about his long history of struggles with addiction beginning as a teenager, using “anything and everything” by the time he was 16. Most recently, he checked himself into rehab just this past March.

As a doctor who treats opiate addiction every day in my office in San Francisco, I see many accomplished people like Cory who are working hard to get and stay clean.

Unlike the myth of addicts being complete train wrecks — barefoot and disheveled — my patients are high-functioning. They are lawyers, computer programmers, housewives, construction workers and entrepreneurs. They work, raise families and contribute to their communities.

I help each of them plan for relapse because the likelihood is so high and the risks are so deadly. After a period of being clean, the body’s tolerance for opiates lowers and doses previously used become deadly.

Sadly, it’s not entirely surprising that Cory’s overdose came after a recent rehab.

Brain chemistry has a lot to do with why relapse is so common. Opiates have an intense effect on the brain. They are engineered to make you feel really good and they do this so well that within a short time of using, it becomes very difficult to feel “normal” without the drug. Even after months or years of being clean people struggle with withdrawal symptoms of depression, anxiety and insomnia.

When the going gets tough, people in recovery need something other than opiates to help them through. Preparation is the key to prevention.

In my practice, I combine medications with mind/body training. There are several FDA-approved medications, like buprenorphine, that can help people get off the roller coaster of opiate addiction. Within a few days of taking the medication, cravings are gone for the vast majority of people.

Buprenorphin, isn’t a cure-all, but it does save lives. It helps the brain to start healing and creates some breathing room for people to learn healthier ways to manage the ups and downs of life.

Relapse is virtually a given unless patients learn skills to reduce anxiety and sleep better, get nutrients that best support brain, body and recovery and develop tools for dealing with cravings, withdrawal and pain.

The brain can heal. It’s not easy, but I’ve found when people understand how opiates work in their brains, they are better able to take their recovery in new directions.

By Alex Zaphiris, MDFrom: http://psychcentral.com/blog/archives/2013/07/20/cory-monteith-a-wake-up-call-about-relapse/

Clean: Overcoming Addiction and Ending America's Greatest Tragedy

I finished reading Clean yesterday. As I suspected, it was a hard and challenging read for me.

I think the biggest issue I have failed to realize with my ex-husband's addiction is that he likely has a dual diagnosis of addiction and some sort of mental illness.

David Sheff devotes and entire chapter to "Treating Dual Diagnosis".  This was one of the most enlightening segments for me.

I still don't know if my ex-husband is
A) an asshole because he is an addict
B) an asshole because he is mentally ill
C) just an asshole

I suppose it really doesn't matter.

What I have seen again and again in women who are in relationships with addicts is that they are treated poorly.  In almost every case.

So that's the tough part for me.

Sheff does acknowledge, "Another symptom of addiction is narcissism." 

Sheff did bring me a little closer to believing addiction may be a disease, and I will share many of those quotes in the weeks to come. That still doesn't feel completely true to me though.

I think learning as much as we can about addiction is helpful. I certainly wish I knew more walking into my previous relationship.  I likely would not have gone further with it.

As I said in a previous post, I do believe this is a critically important book.  It is certainly the book I would want if my children were addicts - or if I did happen to be one of the few women who was in love with an addict who treated me well.

For those of us who are left with the crumbs of a life destroyed by an addict, I suppose we need a different book. I still don't think there is nearly enough good information out there for women affected by the selfishness of an addict.

More than anything, our children need us to read that book. Because one thing I am sure of is that addiction is often learned behavior.  We need new paths for our children.

I hope, like Sheff, that one day we will have a cure for addiction. But I wouldn't hold my breath and put the lives of my children at risk waiting for it to come.

The Junkies' Wives Club

This is a great site that I have utilized a lot in the past. There are not a lot of forums out there for families struggling with addiction that don't push Al-Anon down your throat. You will find people struggling with spouses of all sorts of addictions on this page. Some use traditional 12-step programs, and others don't.

You can be as anonymous as you want to be. But most importantly, it is a place to vent without judgment and be supported by other women who have either been there or are still there.

http://jwclub.ning.com/

Why didn't anyone tell me?

(Shared with permission by Margaret Clapp)

Why didn't anyone tell me this was a no-win situation? Why didn't anyone tell me how "supporting my husband's recovery" would destroy my kids? I think they should post some stats of actual long term opiate recovery outcomes at meetings. This is lifetime of descending levels of hell for the families.

Over the past six years, I sold my soul, compromised my identity and values, wasted my savings, irreparably destroyed my self esteem and most horrific of all, damaged my precious daughters. For what? To keep "my marriage together", so my kids wouldn’t grow-up without a "dad". They have a "dad" alright. A "dad" who taught them, by constant example, how to lie and avoid responsibility. This is not life I imaged for myself or my lovely children.

I was never stupid or weak. Just the opposite. I am well educated. I was fit and cute and funny. I worked hard and success came easy for me. I had a supportive family and strong network of friends in a lovely upper middle class neighborhood. Notice the past tense.

In 2005, I discovered my husband had a “problem". He was coming home from work falling down high, pissing in the hallway, sleeping/watching for days, then he went off the wall, screaming, agitated, violent. You all know the drill. I was scared. I wanted to help him. I loved him. He loved me. We had two kids. I would stand by him and he would get through this. After all, we were married for better or worse.

Over the next four years I thought I was insulating my daughters form the chaos of their dad's addiction. He never drove them in car. The kids were busy at school, sports, homework, social events, spent allot of time with grandma. I took on the roll of mom and dad. put on a happy face and took care of business. All the while, demonstrating, through my daily example, how to be a doormat, how not stand-up for your rights, that a wife is not entitled to love, affection or respect, that a wife was a target for blame, that wife should never expect the truth, that lies are tolerated in marriage, that marriage is not a partnership. I allowed this to happen.

Worst of all, they knew. My sweet young daughters knew I was compromising my integrity and self respect for the sake of a drug addict. My kids, by extension, also comprised a significant portion of their childhood for a drug addict. They had no choice. They grew-up in home without trust, without respect.

At some point, I realized that he (my Opiate-addicted husband) was not married to me. The love of his life came in a pill (Oxy, Vicodine, etc). Weren't fathers supposed to put forth effort and make sacrifices for the family? His efforts and sacrifices are for drugs. He wasn't my partner in building a future our daughters. His partner is opiates. His future is getting high.

If you're still trying to be the best wife and mother possible, please stop believing everything will be OK. Every lie you ignore, every dollar missing, every late night wondering when he’ll arrive home is one more chip away from your soul. Your kids are bearing witness to your slow decay.

GRAB the kids and RUN. Why? So you don’t end-up a soulless disaster. Run. NOW. Today. Run for your life. Don’t stop until you are free from the lies and pain of someone else’s addition . Run fast. Run while you still have love in your heart, before hate overtakes your soul. Run.

Addiction

"...nearly all people are prone to addictive behavior and spirituality is the only cure for addiction."

-Charlotte Davis Kasl, Women, Sex and Addiction: A Search for Love and Power. (xiii)

The Alcoholism and Addiction Cure

I read this book several years ago, and I really liked it. A very different approach than AA. Since I have been thinking about other ways of doing things.

He starts the book with a pledge, and I remember when I opened the book, it seemed very far fetched to me, based on my experience with my husband and all his relapses.

My Pledge to you
cure n 1) Restoring to a sound or healthy condition.
2) A Healing

What Prentiss says is that you can not recover unless you heal the underlying causes for your addiction. He primarily uses the example of his son - but they have since opened their own rehab center in California. There is a very touching chapter about his son's story, which Pax writes.

My dad had never given up on me, even though I had been doing drugs for ten years. He never gave up on me, no matter how bad things got or how much money I stole from him. Imagine that the belief he had to have had in me to support me in creating Passages when I had continually demonstrated that I couldn't stay sober myself. He knew that I was healed and that I would never do drugs again. To this day, I'm amazed that he decided to help me. He didn't just give me a second chance. It was a fortieth chance, but he embraced it wholeheartedly.

I still tear up when I read this passage, and I remember practically sobbing when I initially read this chapter. What really gets me is how kind his father was to him throughout the process. He had a belief that that was what his son's journey needed to be, and so he never judged him or put him down.

I can't help relate the story to my husband and his father. Even though my father-in-law was also an alcoholic and is "in recovery", the way he talks to my husband is so terrible. He will slam the phone down on him and say "I'm done with you." They cuss and swear at each other. It is truly disgusting. I have never understood the way they talk to each other. I remember the fourth wife's email saying that I don't know how people talk to each other in the "real world" when the "going gets rough", and I think, I don't know anyone who talks to each other this way. And I certainly don't think it helps with anyone's recovery.

He also says that alcoholism and addiction are not diseases. "All dependency is a symptom, not a problem" (17)

To give up our power to change for the better is inherently distasteful to everyone, and to force people to affirm that they are addicts or alcoholics so they can speak in a meeting is shameful and demoralizing. The stigma attached to those labels is so great that most people won't tolerate it. Such declarations ruin a healthy self-image. They convince us that even if we obtain sobriety, we remain broken instead of whole, spoiled instead of fresh and new....

A small benefit attached to that admission - a reminder that the former alcoholic is constantly at risk of relapsing- is far outweighed by the poor self-image it creates. In fact, that poor self-image is what contributes to their relapse. (135)

One reason he gives for why rehab does not work is that there generally not enough individual sessions. "At the end of the first week, everyone in the room knows everyone else's story. That goes on for three more weeks, and then most people go home with the same problems they brought with them when they arrived." (133)

Most addicts and alcoholics relapse not just once but many times...Relapse is not part of recovery. Relapse is part of failure. Relapse is return to dependency. Sobriety is part of recovery. You may now be starting to understand why the relapse rate is so high - it's because people are just trying to quit without curing the underlying causes, which is like trying to stop scratching while your leg is still itching. (139)

He says there are only 4 causes of dependency:
Cause 1: Chemical imbalance
Cause 2: Unsolved events from the past
Cause 3: Beliefs you hold that are inconsistent with what is true
Cause 4: Inability to cope with current conditions (145)

I do not list genetic tendencies as a cause of dependency for two reasons. First, they are only tendencies, and while they may predispose you to becoming dependent on alcohol or addiction drugs, you don't necessarily become dependent just because your ancestors were dependent. Some people have a genetic tendency to become fat but that doesn't mean they will become fat or that they must become fat. There are many people who are completely sober or who can drink socially, even though their parents and grandparents were dependent on drugs and alcohol. (146)

There are so many great passages in this book - my copy is all marked up...I would highly recommend it to anyone.

Drug Use Beyond Genetics

Good parenting provides a potent buffer against some youngsters' genetic predisposition to use alcohol, cigarettes and marijuana by age 14, a study finds. Uninvolved, unsupportive parenting heralds a spike in consumption of these substances among genetically vulnerable teens, a team led by psychologist Gene Brody of the University of Georgia in Athens reports in the February Journal of Consulting and Clinical Psychology.

Science News, Feb 28, 2009 by Bruce Bower

AWOL

I rear ended someone yesterday with both my kids in the car on the way to school. Luckily, he was a very kind man. He was more worried about how my kids were doing than the damage I did to his car. For all my complaining about my enormous Suburban, that car is a tank. There was very little damage to my car whatsoever. His, on the other hand, looked pretty bad.

It turned out that the man was a Muslim from Jordan, so we had a nice visit in the midst of everything.

The kids and I were all pretty shaken up. They hadn't been in any sort of accident with me - and I haven't been in an accident for probably 15 years. So much for my perfect driving record!

But at least I have insurance and it shouldn't be a major deal.

I tried to get ahold of my husband afterward and couldn't reach him most of the day. I started to panic. As the day wore on and I didn't hear back from my texts, emails and phone calls, I imagined that he must be in jail or dead. I started swirling around in my head.

Luckily I had lunch with a great old friend and she kept me grounded. After that, I started swirling again on the way to meet my sister. I almost called my father-in-law several times, but stopped myself. There is nothing he can help me with.

I asked my sister anyway whether she thought I should call my father-in-law and she practically laughed and shouted NO!!! No contact with him ever!!!

She is right. But there are situations like that where I feel so desperate I would do almost anything. It made me realize that I still have a lot of healing to do around this. If I ever am to get in another relationship (which seems doubtful at this point!) I am going to have to deal with this. Even for my own sake and that of my children when they are grown - it is just too hard to go down that road. And, I have been here enough times I should know that. But when my husband is AWOL, even now, my mind goes to the worst possible place.

Sex Addiction: A Disease Or An Excuse?

Saw this on NPR yesterday and thought it was very interesting....

March 5, 2010
By Kathleen Masterson

Sex addiction, nymphomania or sexual compulsion might sound like the stuff of novels or over-hyped celebrity angst. Yet excessive sexual behaviors have been documented for over two centuries in American medical literature. In fact, one of the signers of the Declaration of Independence, Benjamin Rush, wrote about it in his book Medical Inquiries and Observations upon the Diseases of the Mind, the first textbook of mental illness in the U.S.


Treatment for mental illness has come a long way from the days of simply throwing people in a "madhouse," like this 1917 lithograph shows. (George Bellows/Library of Congress)

Rush wrote that sexual appetite, "when excessive, becomes a disease both of the body and mind." He also concluded that "promiscuous intercourse with the female sex" or excessive masturbation could cause impotence, dyspepsia, vertigo, dimness of sight, memory loss, and even death. (He didn't mention the risk of political downfall, loss of sponsorships, or inescapable media obsession.) Still, even though excessive sexual behavior has been described for a long time, it has yet to be officially recognized by the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Instead, the category resides in the book's appendix.

Dr. Martin Kafka, a Harvard professor and psychiatrist at the med school's McLean hospital, and his colleagues are trying to push it out of that back-of-the book diagnostic "wastebasket." They're proposing that "hypersexual disorder" be added to the next edition of the DSM. Kafka says research over the last few decades supports that idea that these extreme sexual behaviors are symptoms of a mental disorder.

The problem goes beyond just having a lot of sex; it's when a person cannot stop engaging in things like promiscuity, porn, masturbation -- and this behavior causes significant impairment and stress in the person's life. (It's worth noting that even the DSM struggles to actually define what a mental disorder is. The working definition is that it's a clinically recognized syndrome that causes serious distress or impairment of the person's ability to function.)

The proposed hypersexual disorder would be categorized alongside other sexual disorders, such as fetishistic disorder and exhibitionistic disorder.

Criteria for hypersexual disorder would include spending a lot of time consumed by sexual fantasies and repetitively engaging in these sexual fantasies in response to stress, anxiety, boredom or depression. The person also makes repeated but unsuccessful attempts to control the behavior, and engages in the behavior disregarding the risk of physical or emotional harm for himself or others. And, to be diagnosed with hypersexuality, this behavior would have to cause the person significant distress or impairment.

That last criterion is the kicker -- the person needs to present with "clinically significant personal distress." And how do you measure that -- as opposed to say, a politician who is caught sleeping with another woman and blames a sex addiction? Drawing the line between guilty indiscretions and an actual mental disorder has a lot of the public skeptical.

"It's not often a condition you can tell from afar," says Kafka. "The only way to know if it's a moral excuse or a real disorder takes knowing the person, the extent of the behaviors, have they tried to control it, what risks have they taken."

Kafka and the working group stops short of calling the sexual problem an addiction. He says the science just isn't there yet to prove that the behavior is addictive, that it operates the same way as, say, alcohol dependence. Addictions are defined by out-of-control drug use, cravings and activation of the brain's reward centers. There just hasn't been enough research to show that excessive sexual behavior works the same way as drug dependencies, says Dr. Charles O'Brien, the vice-chair of psychiatry at the University of Pennsylvania and director of UPenn's Center for Studies of Addiction.

With someone with extreme sexual behavior, he says, " if you show them porn, it does activate this part of the brain (associated with addiction), but we don't have any evidence that this is associated with a loss of control. In the case of an addict, the brain activation makes them want to go out and use the drug."

Instead, the proposed category would label the behavior as a disorder, more akin to anxiety or depression.

Even without an official category for hypersexuality, people do seek help for this kind of sex problem. Currently most people are treated with fairly standard addiction treatment, says Kafka, which might mean individual therapy or 12-step groups based on chemical dependence quitting programs. An NYT reporter noted that Tiger Woods public apology speech mirrored several steps of the common 12-step recovery program.

Does the treatment work? The scientific literature on treatment varies, says Kafka, and much more study is needed.

Typically, when a new mental disorder gets added into the DSM, its inclusion stimulates a good deal of research on the topic. If accepted, the new definition could help garner more scientific attention.

Addiction: Episcopal Perspective

Cynthia Bourgeault replies:

A:It’s not really a question of “mind over matter” because the mind IS matter!

As recent neuroscience has demonstrated, every habit lays down its own neural pathway i.e., it carves its own rut track in the brain – and the inertia around these pathways is considerable. The disruption of ANY happy pathway brings with it considerable discomfort and resistance. So you’re quite right in lumping together habits and addictions; the difference between them is more one of degree than of kind. One can be addicted to coffee, alcohol, porridge for breakfast, endorphins, heroin, meditation, exercise, sex or God! The difference is only that the classic “chemical dependency addictions” add to our already full plate of cognitive and emotional distress and at the interruption of a habit, physiological distress as well.

Most of the moral and spiritual training of Western minds over the past two millennia has been couched around instilling “good habits” – or at least replacing unhealthy behavior patterns with healthy behavior patterns. But there has been a school of spiritual training in all the great traditions that claims that real spiritual maturity is the ability to be habit-free: to be able to bushwhack through consciousness without laying down ANY of those familiar but deadly ruttracks.

My own teacher Rafe belonged to this school of thought. On his prayer desk, he kept a quotation from the British spiritual teacher Maurice Nicoll: “Faith is a continual inner effort, a continual altering of the mind, of the habitual ways of thought, of the habitual ways of taking everything, of habitual reactions.” Rafe took that saying deeply to heart. From time to time, he would spontaneously uproot his established patterns and preferences in order to keep his spiritual life (as well as his mind) supple, and to experience that pure rush of freedom that comes from being able to sit in the chaos of a disrupted habit – like an anthill that’s just been kicked in – and transform the pain into the razor’s edge of pure consciousness.

To do this, however, is an advanced spiritual skill. It requires an ability to sit in the presence of powerful emotional currents – pain, grief, yearning, fear – and experience them as pure sensation rather than as part of the story we keep telling ourselves about who we are. This is an acquired skill, whose foundations are in meditation and conscious breathing.

Both habits and addictions, in my experience, are a kind of shorthand we resort to for getting through our lives because we lack the spiritual/energetic force to stay present to the field of our own “pure awareness.” Our habits are primarily the SYMPTOMS of our low level of Being, not the CAUSE of it. So my own preference is to work a little each day on increasing my tolerance for Being (or presence or pure awareness – they’re simply different ways of speaking about the same vitalized energy field of consciousness). Once that force of Being is strong enough within us, then dealing with habits/addictions is like taking off a raincoat once the sun is shining.

Cynthia Bourgeault

Cynthia Bourgeault is an Episcopal priest, writer and retreat leader. She is founding director of the Aspen Wisdom School in Colorado and principal visiting teacher for the Contemplative Society in Victoria, BC, Canada

Addiction: Deepak Chopra

Deepak Chopra replies:

A:Addiction Is a Mystique and a Mystery
Human beings become addicted because we are complex. Addictions are like a jigsaw puzzle where all the pieces are on the table but no one quite knows what the whole picture should be. Here are the main pieces:

1. The addictive substance or behavior
2. Brain chemistry
3. Social pressure for and against addiction
4. A vulnerable psyche
5. The X factor

It’s important to understand all five elements, because leaving anyone out leads to false hope and tragically, temporary cures (or no cure at all). If you have a family member who’s an addict, don’t form an opinion until you have looked at every piece of the puzzle. You don’t want to fall into the trap of blame and shame, which is always waiting when addiction starts creating intense stress in a relationship.

The addictive substance or behavior: This piece of the puzzle has always grabbed the headlines. A hundred years ago it was “demon” rum and whiskey. In the fifties, the demon became heroin, now it’s crack. In reality, no substance is a demon. The ability of a drug to induce pleasure isn’t an evil. There must be another element, or a number of them, to turn any substance addictive. Millions of people try cocaine, heroin, LSD and marijuana and then walk away. The ones who can’t walk away are different, and it’s that difference we must isolate and heal. The same goes for addictive behavior such as overeating or craving power or the need to control.

Brain chemistry. Drugs change the brain by affecting receptors in your brain cells that exist for pleasure and the cessation of pain. If you take any substance long enough, the brain adapts by altering its receptors, and then the trouble begins. The burned-out addict is actually a burned-out brain. When pleasure receptors are overloaded, then they no longer transmit signals of pleasure. Instead, the addict finds himself fending off pain. This becomes the chief reason for getting high, and it marks a far more desperate phase of addiction. When your whole purpose in life is not to feel agony, existence becomes hollow and meaningless.

Social pressure. Although we all have an image in our minds of the secretive addict shooting up or drinking alone, society always plays a part. Cocktail parties are social events that permit people to escape social rules. They are temporary vacations from inhibition. They are also group bonding sessions, as is passing a joint. Social pressure is complicated. It can work to encourage belonging, but it can also throw you out of the group and make you an outcast. Addicts experience both sides. Before they are labeled addicts and shunned by society, they went through an early phase of trying to belong. The net result is a deep confusion about where they stand with family and friends.

Vulnerable psyche. Addicts aren’t weaker than other people, nor are they morally deficient, irrational, stupid or undisciplined. All those labels are used by outsiders who want to judge against the addict. If you discard moral self-righteousness, the reality is that addiction preys upon some kind of psychological wound. It seems to cure the wound at first. The first high is often described by addicts as a kind of miracle cure or religious euphoria. Their reaction is extreme because at a deeper level they are seekers of healing. A hidden trauma or unconscious need has been searching for a cure. It quickly becomes obvious, however, that addiction mimics a cure – it is actually only a distraction or an empty escape. What the addict really wants – a sense of meaning, a grip on reality, a self that doesn’t feel impaired – still hasn’t been found.

The X factor. Having figured out the first four pieces of the puzzle, a great deal of good can be done. Addicts can be brought to healing and self-knowledge. They can be weaned off substances and their brains (slowly) returned to a more balanced chemical state. Yet there remains the X factor. Call it a predisposition, karma, the unconscious or a perverse urge to self-destruction. For some addicts, the journey of addiction is existential. They want to experience a kind of “left hand path,” to pick up a term from Indian spirituality. Wrestling with the devil tempts them into a private melodrama of the soul. The lure of temptation is seductive to everyone, not just addicts. Ultimately we want to come through to the other side. The point isn’t self-destruction (except in some rare cases), but finding safety and a better reason to be alive.

Added up together, these five pieces give us understanding about what creates addicts. They also explain why we are such an addicted society. As the result of more leisure, money and the absence of old moral strictures, along with a craving for distraction, modern America is an addict’s paradise. The term is used ironically – in which we are all free to define our own existence. In other words, we are free to explore human complexity. This isn’t to make light of addicts. They can cause enormous harm to themselves and others (always remembering that the greatest harm by far isn’t caused by exotic or illegal substances but by alcohol).

It turns out that there will never be one picture of addiction, even when all the pieces are on the table. Each addict is unique. The pieces fit together differently from one person to another, and in the end, the X factor counts for a lot. As long as addiction enjoys a mystique that is at once forbidden, criminal, tempting and scary, no one will discover a rational solution. Too much of our irrational side comes into play. Hard as it may be, coming to terms with any addiction means coming to terms with the complexity of a life journey, with all of its dark passages and hidden motivations.

Deepak Chopra

Deepak Chopra is President of the Alliance for New Humanity (www.deepakchopra.com and www.anhglobal.org). Deepak Chopra’s new book, Jesus: A Story of Enlightenment is available at Amazon.com.

Addiction: Psychological Perspective

Dr. Karen Binder-Brynes replies:

A:Over the years as a psychologist, I have treated countless patients who have suffered from one form or another of “addiction.” Whether it was the woman whose whole body was marked with needle marks from her secret heroin addiction, the young girl addicted to binging and purging or the good-looking athlete, wasting hours of his days with video porn...all suffered terribly from something that has most likely plagued humankind from the beginning of time – addictive behavior.

Addiction, in my view, has two basic elements. These include the tolerance and withdrawal phenomenon. Tolerance basically means that over time, more and more of the addictive behavior or substance is needed to achieve the desired effect. Withdrawal essentially means that the individual has a very painful physical and/or emotional reaction when the substance or behavior is ceased. Addiction is probably one of the most costly and serious problems facing our culture today. If each of us stops to reflect, we can probably all come up with at least one negative addiction we have or have had in our lives that has caused pain and suffering.

There is much controversy in the medical and psychology worlds in terms of what the exact nature of addiction is. I tend to gravitate toward a multi-leveled, biopsychosocial model as a theorem for explaining addiction. Although historically addictions were usually regarded in terms of psychoactive substances, such as drugs, that when ingested caused chemical alterations in the brain, the current thinking has broadened to include other compulsive behaviors such as pathological gambling, shopping, eating, etc. In our current lives, even “working” can be addictive. In fact, so commonplace are addictions, that we have adopted the terminology “oholic” for many behaviors, e.g., alcoholic, shopaholic, workaholic and so on.

Without getting too technical, it is now accepted that the human brain, like many animal brains, is organized to prefer one outcome over another. In essence, “all sentient beings have developed in such a manner, through natural selection, that pleasurable sensations serve as their habitual guides” (Darwin, 1958:89). Basically what this means is that most addictions can be traced to an activation of the brain’s pleasure and reward systems. What I am saying is that humans and other animals will seek to find pleasure and for the most part, avoid pain at all costs. This makes intuitive sense as well as being a biological reality. Now the question becomes whether or not one’s individual will can ignore, overcome or avoid the temptations of those habits, which ultimately turn from pleasurable and rewarding to destructive and often life-shattering addictions.

Why some people become more prone to addictions than others is a matter of great debate. The arguments range from a strict “disease” model suggesting a biochemistry of addiction, perhaps with genetic basis, to a “choice” model (Szasz, 1973) suggesting that the addict is a person who chooses a taboo substance or behavior to a low-risk lifestyle. Regardless of the causes, addictions can be costly and cause tremendous suffering for not only the “enslaved” person but for their families, friends and society in general. If you or someone you know is addicted to substances or destructive behaviors, it is never too late to get treatment. Denial and shame are often deterrents to seeking assistance. Never lose hope that you or a loved one can get help and beat an addiction. People can make miraculous recoveries from the powerful grip of addiction. I have seen it!

Dr. Karen Binder-Brynes

Dr. Karen Binder-Brynes is a leading psychologist with a private practice in New York City for the past 15 years. See her website, drkarennyc.com, for more information.

Addiction: Zen Perspective

Zen Master Dennis Genpo Merzel replies:

A:I think it’s important to first understand the root cause of all our addictions. Our major addiction is to the self and all that we consider to be the self, in other words, to my body, my mind, my ego, to my beliefs, concepts and opinions, and to my desires, cravings and attachments. Most of our addictions are to avoid the truth that “I” does not exist as a separate entity, and we use our drugs of choice to help the “self” feel better temporarily. To realize “no-self” is to face true emptiness or the void that we are always trying so desperately to fill.

Our addiction to the concept of self is the most deeply ingrained and the hardest to overcome. To do so we have to begin by seeing into the truth that there really is no self. The self is just a concept, an agreed-upon notion, much like that of a corporation. Over a period of 80 to 100 years, the CEO and all the employees will have changed several times. The product and even the name of the company may also have changed. So what is the company? In fact, there is no company, other than a legal agreement that it exists and persists over time as the same company. The self is just like this. We know that before there was a concept of self, there was no such thing called the self. We all agree when a baby is born that this baby is a self and has a self. But the baby doesn’t have a concept of self. We build that concept up over time, and the more time and energy we invest in the concept of self, the more attached, or addicted, we become to the notion that “I” exists as a separate, solid and permanent entity. Moment by moment, day by day, year by year, the more we have invested in this notion, the harder it is to free ourselves from the addiction of self. Once we have truly realized that there is no self, the easier it is to drop our addictions.

From this notion of self comes all our suffering. When we realize there is no self, there is no suffering, for there is no one to suffer. However, this is not the end of what is possible to realize. Imagine a triangle with “the self” at one end of the base, and “the no-self” at the opposite end of the base. Then envision moving to the apex of this triangle and embrace the two aspects of the one reality: the relative, the self; and the absolute, the no-self. And since the relative and the absolute are one in reality, just two opposite ends of the same triangle, we realize that the no-self is the self.

At this point, we are totally free to choose to be a human being. We can choose our addictions wisely. I choose to have my cup of coffee in the morning. I choose to avoid harmful substances or behaviors. I choose to be attached to my family, friends and loved ones. I choose to be attached to helping all beings awaken – and it too is an addiction!

Zen Master Dennis Genpo Merzel

Zen Master Dennis Genpo Merzel is the founder of Big Mind Big Heart – A Western Zen Approach to Life and head of Kanzeon Zen International. His latest book is Big Mind, Big Heart: Finding Your Way. For more on Genpo Roshi’s work, visit www.bigmind.org

Addiction: Kabbalah Perspective

Michael Berg replies:

A:I Want More

When looking through the lens of Kabbalah, addiction is seen as a positive door to greater personal transformation, provided we understand these urges are coming from the soul, not the body. In a way, it is the deepest, truest part of ourselves saying, “I am not satisfied.”

Kabbalah teaches that we are in this world to achieve lasting and true fulfillment. However, our wires often get crossed and we think this fulfillment can come from physicality. This is never the case. The material world always leaves us wanting more. There is a saying, “If today I have one then tomorrow I want two, and if today I have 100, then tomorrow I will want 200.”

The addiction battles many of us fight are here to push us toward finding a deeper fulfillment, which comes from connecting to the real things in life: love, compassion, sharing and revealing our true essence.

Addiction is simply a misguided yearning of the soul. What happens with alcohol, drugs, sex and money is that they are short-term fixes for this deeper desire. Sure, in the moment, they give us a certain amount of fulfillment, but as we know it never lasts.

Our soul has this massive thirst, and we are trying to quench it with a teaspoon.

Therefore, there are three essential things we can do to begin the process of leaving addictive behavior behind:

1. Realize these yearnings are coming from a true place (our soul) telling us we need to do more, and we can do and be more.

2. Begin a process of both realizing and connecting to our true essence by focusing, meditating and becoming more conscious of our thoughts, behaviors and true potential.

3. Do actions that take us out of selfish behavior. Become a more giving person. This helps us be less busy with ourselves.

Being addicted doesn’t make us bad, weak or hopeless. Just the opposite. It means we have a unique soul that wants more. We aren’t satisfied with the status quo. We have a burning desire to connect to something bigger than ourselves. And as we come to understand the source of our desires, and stop letting our addictions distract us from our true essence, we can find a lasting, uninterrupted level of fulfillment.

Michael Berg

Michael Berg is co-director of the Kabbalah Centre™.

Addiction: Sufi Perspective

Shaikh Kabir Helmsinki responds:

A:I’m sure there are addiction counselors who could share their knowledge and give excellent answers to these questions at the psycho-physical level. In the end, however, most addiction counselors themselves would acknowledge that the spiritual level is where these questions will be most adequately answered.

First of all, let’s be compassionate with ourselves and toward people who try to deal with the pain of life through addictions. These are sometimes the most sensitive people among us. What we experience as the pain of life is really a call to the transcendent level of human experience. Addictions are both misguided attempts at self-transcendence and ways to numb ourselves. Intoxication shuts down parts of the mind, frees us of inhibitions and opens us up (sometimes). Sexual addiction brings a rush of emotion and sensation. Other less dangerous addictions are still just numbing dead ends in the long run.

Meditation, and any true spiritual practices, such as meditation, singing/chanting or body-prayer, may also be repetitive activities, but they point us toward a dimension of experience that is not a deadend of physical dependency, but, rather, an infinite opening to an ever-changing reality. This connection with the transcendent level of experience is not an abstract aloofness. The experience of the sacred and holy leads us back to life. It can be integrated with the immanent experience of our daily life, livelihood and relationships. We need to bring the transcendent, the holy, the sacred into our lives. But it is in the nature of addiction to also be in denial, to justify our futile, repetitive, self-defeating ways.

Transformation becomes possible when the soul in its state of addiction can say: “I don’t want to feel this way, live this way or be this way. Help me...”

The Infinite understands all languages and answers, and in some way, all calls.

Have you noticed the intensification of time lately? There’s so much pain and confusion out there. At the same time, the Infinite is beckoning, inviting with an unprecedented insistence.

Kabir Helminski

Kabir Helminski is Shaikh of the Mevlevi Order, Co-director of The Threshold Society (sufism.org).

Perspectives on Addiction

I found these different perspectives on Addiction and I thought they were very interesting, so I will be posting all of them in time.

Addiction is defined as “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, such as narcotics, to such an extent that its cessation causes severe trauma.” What makes so many of us prone to addiction in its various forms? What causes us to be open to this enslavement? And how do we begin to undo it?

-Goop, Nourish the Inner Aspect

Sleep = A Clear Mind, finally

I finally got a full night of uninterrupted sleep and am thinking much clearer. It has been months since this has happened. I usually take hours to get to sleep and wake up 4-5 times during the night. My mother talked to me yesterday about how important it is for me to sleep well, and she was right.

If nothing else has come out of these stomach pains, it is the realization that I have not been taking good enough care of myself. I have told myself I am doing better than most under the circumstances, but I was comparing myself to other Al-anon-ers - not most normal people. I am going to take a look at how I can do a better job.

My mind has been wandering with all these scenarios that "might" happen. I realized this morning that it really is not up to me. I have children. And, as my husband likes to remind me, he has "rights" as their father.

I can control the situation somewhat with my children now because my husband has not been an active participant in our lives. But ultimately, if we divorce, a judge will decide everything.

I have given my husband a guilty verdict in my head again and again. But ultimately, it will not matter what I think. Only the facts will matter.

I can present my truth to a judge, and it may or may not matter. Some things are undisputed. My husband has a felony conviction for cocaine possession. My husband has been in rehab twice for a total over 5 months during the span of our relationship. My husband has relapsed or "slipped" (as he likes to call it) several times since then. My husband has driven drunk with us in the car. My husband slept with 3 women without a condom. All of these things I have proof of. The rest, all the little bitty things that I have been fixated on, are not going to be relevant in court.

The judge can subpoena my husband's bank records and he can explain where the money has gone. He can give an account line by line. And I can explain all the sacrifices we have made and how many times I have had to make his children pasta or macaroni and cheese. I can show the 401ks that I had to liquidate to stay afloat. S/he can look at my bank records and see that we were left with nothing.

A judge can talk to the school. S/he can talk to the teachers. S/he can talk to my son's counselor. S/he can talk to the people at our church and in the Muslim community. S/he can talk to anyone and see what the patterns have been over the years and what the effects have been on our children.

A judge can look at all of this and make his (or her) verdict. And that will dictate what happens from here on out. If my husband does not pay support, he will go to jail. Our State is very tough on this. All of this is very simple. I have been making it hard, but it is very simple.

And once that happens, we can move on with our lives. There will be no more "what ifs". We won't have to wait for him to pay the bills or beg for money. We will know what the law allows for every month and the State can take it straight out of his check.

If my husband continues to read my blog and harass me about it, a judge can address that as well. If my husband verbally abuses me, sends me menacing text messages and/or voicemails, or physically attacks me again, there are measures a judge can take about that as well. I do not have to just sit here and continue to take it, and I won't.

It can only get better from here.

The Health Effects of Teen Alcohol Use

I have been thinking a lot this morning about the damage inflicted upon my husband by his father. Primarily, the alcoholic damage - because there is a lot of damage I could talk about. It seems to be never-ending.

If you cause an accident which causes brain damage or any other damage to a person physically or emotionally, typically you are sued and forced to pay for that damage.

When you give a child alcohol at the age of 12, and reinforce alcoholic and dysfunctional behavior their entire childhood - you promote a pattern that is difficult to escape.

When you provide alcohol to a teenager, when their brain is developing at its most critical stage, the brain never fully develops or recovers.

I have been thinking this morning about all the ways that my husband never seems to be able to fully get things together. The way it takes him over an hour to get ready in the morning. How we are always waiting for him (when we live together). He can not seem to make simple choices. In his career, how he always seems just shy of making it. And now we blame that on ADD - but I really wonder what connection that has to drinking as a child - and if his "ADD" is either caused by or simply the result of his father's negligence.

And quite frankly, it outrages me. I think all children of alcoholics should be entitled to damages. Damages for growing up in a fucked up environment. Damages, in my husband's case for the harm caused by drinking alcohol at such a young age. Because I can tell you this, most children do not make that choice. I was never given alcohol as a child. I don't know many people who were (other than perhaps a sip of something). But when you give a child beer or other alcohol, you should be prepared to face the consequences - for the rest of your life. Because the repercussions from that irresponsible action will follow that child for the rest of theirs.

Here is just one article I found, but the body of evidence is enormous, and something I am going to start paying more attention to.


The Health Effects of Teen Alcohol Use

There has been many studies conducted on the health effects of both short-term and long-term use of alcohol among adults. Long-term risks inlcude liver damage, pancreatitis, certain cancers, and literal shrinkage of the brain. Alcohol use is the second leading cause of dementia; one simple ages quicker on alcohol. (3) But professionals today are worried about a steady increase in teen alcohol abuse and the possible negative health effects. According to an article published by the British Medical Association (BMA) entitled: “Alcohol and Young People”, “…there was a general rise in the proportion of 11 to 15 year-olds who drink alcohol regularly, but also there is an increase in the amount they are drinking on each occasion.”

Adolescence is a transition time when the body is undergoing many significant changes, such as hormonal alterations and brain development. It is also a time when young people start to associate more with friends and associates beyond their childhood contacts. They feel an increased pressure to ‘fit in’ or ‘go along with the crowd’ in order to be accepted socially. These new circumstances can be confusing and difficult for the youth to understand and deal with. Often their ability to make correct or safe decisions is also at a stage of immaturity. Exposing the brain to alcohol during this period may interrupt key processes of brain development, possibly leading to mild cognitive impairment as well as to a further escalation of drinking.

Alcohol is absorbed very rapidly into the blood stream from the stomach lining, in as short a time as 5 to 10 minutes and it’s effects last for several hours depending on the amount ingested and how quickly it was consumed. Females absorb alcohol faster than males because their bodies contain less water. The water dilutes the alcohol and so the same amount of alcohol will produce a higher concentration in the blood. After consuming only 2 to 3 normal strength beers, or 4 or 5 standard glasses of wine, most people will feel less inhibited and more relaxed. Anything consumed after this amount most people slur their speech and become less coordinated and clumsy. Some people have increased emotional reactions. More alcohol could result in staggering, double vision, and loss of balance, nausea, vomiting and an impression of the room spinning.

According to information issued from the U. S. government publication entitled Prevention Alert, teen alcohol abuse showed many negative side effects. “Subtle alcohol-induced adolescent learning impairments could affect academic and occupational achievement. In one study……short-term memory skills were evaluated in alcohol-dependent and nondependent adolescents ages 15 and 16. The alcohol-dependent youth had greater difficulty remembering words and simple geometric designs after a 10-minute interval. In this and similar studies memory problems were most common among adolescents in treatment who had experienced alcohol withdrawal symptoms. The emergence of withdrawal symptoms generally indicates an established pattern of heavy drinking. Their appearance at a young age underscores the need for early intervention to prevent and treat underage drinking. Early alcohol use may have long lasting consequences. People who begin drinking before age 15 are four times more likely to develop alcohol dependence at some time in their lives compared with those who have their first drink at age 20 or older. It is not clear whether starting to drink at an early age actually causes alcoholism. Environmental factors may also be involved, especially in alcoholic families, where children may start drinking earlier because of easier access to alcohol in the home, family acceptance of drinking and lack of parental monitoring.

Aside from the fact that underage drinking is illegal, it poses a high risk to both the individual and society. We will discuss some of the consequences of teen alcohol abuse.

Drinking and Driving
Motor vehicle crashes are the leading cause of death among youth ages 15 to 20. The rate of fatal crashes among alcohol-involved drivers between 16 and 20 years old is more than twice the rate for alcohol-involved drivers 21 and older.

Suicide
Alcohol use interacts with conditions such as depression and stress to contribute to suicide, the third leading cause of death among people between the ages of 14 and 25. In one study, 37 percent of eighth grade females who drank heavily reported attempting suicide, compared with 11 percent who did not drink.

Sexual Assault
Sexual assault, including rape, occurs most commonly among women in late adolescence and early adulthood, usually within the context of a date. In one survey, approximately 10 percent of female high school students reported having been raped. Research suggests that alcohol use by the offender, the victim or both, increase the likelihood of sexual assault by a male acquaintance.

High-Risk Sex
Research has associated adolescent alcohol use with high-risk sex, for instance, multiple partners or unprotected sex. The consequences of high-risk sex also are common in this age group, particularly unwanted pregnancy and sexually transmitted diseases, including HIV/AIDS. According to a recent study, the link between high-risk sex and drinking is affected by the quantity of alcohol consumed. The probability of sexual intercourse is increased by drinking amounts of alcohol sufficient to impair judgment, but decreased by drinking heavier amounts that result in feelings of nausea, passing out, or mental confusion. Binge Drinking. Though most college drinkers would deny it, young people do die solely from drinking. In 1995, 318 people ages 15 to 24 died from alcohol poisoning alone, man of them after a night binge at college. At the University of Virginia, a tradition that has seniors drinking a fifth of hard liquor at the final game of the football season (so-called “Fourth-year Fifth”) has killed 18 students since 1990. (3)



Works Cited


British Medical Association BMA, article Alcohol and Young People, Health 1999
(2) Prevention Alert, Vol. 5 Number 6 May 10, 2002,
ncadi.samhsa.gov/govpubs/prevalert/v5/2.aspx

(3) Author: Kattie Payne, RN, PhD Last updated September 9, 2002, copyright 1995-2004, Healthwise, Incorporated, P. O. Box 1989, Boise, ID 83701.

Taken from teendrugabuse.us

Children Model Your Behavior

I was very curious to watch Mackenzie Phillips on Oprah. I have mentioned here that I always DVR her show and watch it later. This show was of particular interest to me because of her family's drug history.

What I took away from it was something I have always thought. CHILDREN MODEL YOUR BEHAVIOR. When you have your children roll your joints for you, what else can they possibly become except drug addicts? When your kids try your cocaine that you leave out in a bowl when they are 11-years-old and you teach your kids how to shoot up at 16, what else can you expect?

I have very similar frustrations with my husband's family, except that his family seems to be surprised by his addiction. In Ms. Phillips case, they seem to be proud of it.

My husband was given beer by his father as a child, and then, surprise, surprise, he became an alcoholic. His mother used to buy him beer as a teenager. The unhealthy behaviors they both modeled are the same behaviors that I now have to deal with.

I have a real problem with all of this. A real problem. Because his addictions have cause me and my children some real grief and there has been no attempt on any of their part to heal any of that.

You don't give children drugs or alcohol. That is also breeding ground for sexual abuse of all kinds to occur.

What surprises me, is their surprise (and anger) at why I don't want my kids around them when they have made no attempts to make any sort of changes. I have told my husband for years if his father wants to see the kids, he needs to get counseling. Has he done it? NO! But 3 times this week, I have been asked about him seeing the kids.

What the hell is that about?

My kids are precious. I am not letting them around just anyone. I did not bring them into this world to be broken by people who have an obvious disregard for life.

Addiction is generational, in my opinion, because no one steps forward to break the cycle. No one says, this is not acceptable.

I was very proud of Ms. Phillips for stepping forward and telling her story. It took courage. I just hope she stays sober. But somehow, this time, I think she will - because she has finally told her truth.

ADHD and Addiction

My mom sent me this article and I decided to post it because I found it very interesting. It seems like many alcoholics and cocaine-addicts also have ADHD. I have been reading about this connection for a while now and urging my husband to take meds (even though I am anti-meds in general). From what I can tell, addicts who take these meds have a lesser chance of relapsing. Some of this information is addressed below and the article itself had a lot of interesting comments if you want to google it. I would be very interested to read about what effects these drugs have on children in the future - ie, are they more apt to be addicts? Seems like there are lots of questions to be answered here - but this is a start. I welcome your comments!

Now we know why Ritalin works
By Dana Blankenhorn | Sep 9, 2009

Why do stimulants like Ritalin turn ADHD kids normal but turn normal kids into hopped-up screaming meamies?

Turns out it’s all about the dopamine.

Dopamine is a neurotransmitter. It passes signals between cells in your brain. Good signals.

Think of it as a chemical “attaboy.” It is well known as a precursor to adrenaline, and Arvid Carlsson won the 2000 Nobel Prize in medicine for finding this other role.

Recently scientists at the Brookhaven National Lab gave 53 ADHD people and 44 controls a radioactive tracer that would “light up” dopamine receptors and transporters under a PET scanner.

What they found was the ADHD people had fewer of these cells, meaning our brains are less capable of processing dopamine, the chemical “attaboy,” than other people. It’s all gone into the Journal of the American Medical Association.

If you don’t have many cells that process dopamine, the best way to get a healthy dose in your brain is to flood it with chemicals that produce dopamine. Stimulants. That’s why Ritalin and Adderall help ADHD kids. These same chemicals overstimulate a brain with a normal load of dopamine receptors, which is why your kid just gets high on them.

But the study also explains a lot more. Eating stimulates dopamine, so fat ADHDers are self-medicating in the same way as their cousins who try benzedrine or other drugs. So does exercise, which may be why Michael Phelps stays in the pool all day.

This may also be why ADHD “poster boy” Robin Williams reported that, when he used cocaine, he felt quiet, normal, and sane. Cocaine also stimulates dopamine. This may also be why he later became an alchoholic. Alcohol helps stimulate the natural release of dopamine.

This may also be part of what drove Williams to be a comic and actor. Loud applause stimulates dopamine. It may explain why so many other ADHDers are so ambitious, so driven to succeed at their passions. We need more real attaboys to stimulate our limited dopamine receptors.

As an ADHD kid myself, and father to two more, this may also explain something I have found troubling my whole life. I don’t react well to praise. Tell me you like this article and I may just shrug it off. Tell me you hate it and we can have a good argument — well an argument at any rate. Praise doesn’t give me the hit it gives you — I need a lot of it to feel it.

So while some are going to take this study as offering a simple chemical solution to ADHD (more dopamine) I believe therapy is still highly recommended. The real answer lies in self-awareness, using ADHD’s gifts to concentrate and create, while being aware of its downsides and treating yourself more gently as a result.

Word to my fellow ADHDers, of any age, wherever you are. You may not hear the applause, and you may not feel it, but it’s there if you work hard and listen closely.