SOMEONE IN YOUR WORLD IS ADDICTED: OPEN YOUR EYES

In the US Revolutionary War, from 1775-1783 there were 50,000 US casualties.  In the Vietnam War (1955-75), there were 211,454 US casualties, while the Iraqi War, from 2003-2011 resulted in 36,710 deaths and the Afghanistan War, from 2001 to the present resulted in 20,904 deaths (US Military Casualties of War, en.wikipedia.org). Over 40,000 women each year die of breast cancer (Jemal et al. Cancer statistics, 2008. CA Cancer J Clin. 2008 Mar-Apr.).   That’s a lot of mothers, fathers, wives, husbands.   Statistics like that grab us. We’re willing to invest in cancer research and treatment.  We honor our military dead. Yet in 2015 alone, more than 52,000 people died of a drug overdose according to the CDC (Center for Disease Control).  Of those 52.000 deaths, 61%  involved an opiate. Between 2001 and 2014, per the National Center for Health Statistics of the CDC, over 250,000 people have died of prescription drug overdoses. Yet, unless one of them happens to be your son, brother, daughter, best friend, wife, those deaths are largely ignored.

We can distance ourselves from those deaths because “it’s their fault.” After all, “they’re drug addicts.” You don’t see fundraisers for drug addiction treatment or parades to celebrate recovery from drug addiction, at least not very often. Yet, we’ve lost more people to drug deaths (not just heroin, but also prescription drugs) over the last 15 years than we did in the Iraqi and Afghanistan Wars combined, or in the Revolutionary War, and we lost more people in 2015 to drug overdoses than we did to breast cancer. What a tremendous waste.

This is a treatable disease.

 Why aren’t people getting treatment? Only a very small percentage of people with addiction are in treatment. There are several reasons. For one, there aren’t enough treatment resources, and there aren’t enough people who specialize in treating addiction, particularly in rural areas. There is still a lot of stigma and misunderstanding People with addiction are told that they are simply weak-willed, that they could stop if they only wanted to, and they buy into that. They are hopeless and defeated, and they believe that treatment won’t work. Nothing could be further from the truth. Addiction is a disease of the brain, a disordered brain. Once a person is in the throes of an addiction, free will is not operating anymore. As with any disease, people who have been ill for a long time, people who grew up in families rife with addiction, need more intense treatment over a longer period. It’s not easy to find that. It may be expensive.

I listened to an interesting webinar today, presented by the American Society of Addiction Medicine on what the Surgeon General’s Report, Facing Addiction in America, means to clinicians treating addiction. Dr. Thomas McLellan of the Treatment Research Institute was one of the speakers.  He points out that 94% of addictions start between the ages of 12 and 25. So that means that we probably aren’t starting treatment early enough.  Addiction related deaths account for 74% of deaths in the 12-25-year-old age group.

Physicians have a role in this abysmal statistic as well. I can say that because I am one. We have been too quick to prescribe opiates and not good enough at monitoring our patient’s use of them. I think, however, that we are getting a little better at understanding when and how to use opiates, when to not use them, and alternative treatments for pain.  However, what I still find infuriating is the negative attitude that many physicians have towards patients with addiction, even patients who are in medication-assisted treatment. I thought we learned better in medical school. You don’t let your personal biases interfere with your treatment of the patient. I’m afraid we’ve lost that concept in the medical profession.

Unfortunately, addiction is like cancer. If treated early and aggressively, the patient can be saved. But if treated too late, some people won’t make it.  I would be willing to bet that someone in your inner circle is struggling with addiction. Open your eyes. Get them into treatment if possible.

And remember, if people don’t have health insurance, they don’t have access to treatment.

You can read the Surgeon General’s report at addiction.surgeongeneral.gov.

 

 

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YOUR SMART PHONE AND RECOVERY

Technology has come to the world of mental health and addiction. Cell phones figure prominently in our lives now. They can also figure, positively or negatively, in mental health and addiction recovery.

The cell phone can be a gateway to positive help or an avenue to people who perpetuate illness. Patients starting treatment for recovery need to eliminate phone numbers of dealers and “friends” who use. They know that quick access to these people during a tough time can be disastrous. People experiencing depression and suicidal feelings may not use their phone often enough to call for help and support. They tend to isolate. Communicating with dysfunctional family members can exacerbate addiction and depression, anxiety, and suicidal feelings.

Why not use the phone in a positive way that supports recovery? There are many cell phone apps available now that can be helpful to people experiencing depression, anxiety, mood swings, difficulty with sleep, and/or addiction. Some are better than others. There is little objective research at this point to determine how effective these apps are from a statistical standpoint. However, as with all treatment, you get out of it what you put in. These apps are not replacements for therapy with a professional, but they can aid recovery. You have to find what works for you.

I am going to highlight some apps that have been reviewed online. There are many others, but these are recommended by several mental health sites such as Psych Central and Healthline. Most are free.

One of the most interesting is called Reach Out. It was originally developed for use by military personnel but is available to anyone.  This app is geared toward preventing suicide. It can be used by people who have suicidal thoughts and by family members or friends who are concerned about someone who may be suicidal.   For people contemplating suicide, it has several videos that suggest alternatives, give tips on stopping suicidal thoughts and combating the negative, all or nothing thinking that suicidal people have. It suggests activities that can distract from suicidal thinking. The app lists resources for more information about preventing suicide.  It has a Help Center that lists a suicide hotline number and allows the user to list phone numbers of contacts who can be helpful. Of course, people with suicidal thoughts have to be willing to use it. It’s probably most helpful for people who have recurrent thoughts rather than an immediate impulse, and who are willing to consider alternatives.

For those concerned about someone who may be suicidal, the app lists signs of suicidal thinking, makes suggestions about how to approach the person and what to ask. It also lists resources for more information about suicide.

There are several apps that are useful for persons suffering from severe anxiety and panic attacks. One of them is Breathe2Relax. It illustrates the proper technique for breathing during a panic attack. It gives step by step suggestions on how to deal with a panic attack. Another app for anxiety is SAM, Self-help for Anxiety Management. It also provides suggestions which can be used during a panic attack. These apps work best if you take some time to understand them. There are features that are simple and can be used immediately, but with some work on personalizing the settings, they can be more effective on an individual basis.

Depression CBT (CBT stands for cognitive behavior therapy) is only available for Android at this time. It was recommended by Healthline (healthline.com) as one of the 10 best mental health apps of the year. It offers an assessment tool that allows you to follow the severity of depression and offers audio programs that help with anxiety and depression. It directs the user to resources that help pinpoint negative thought patterns that underlie depression. Pacifica, which is available for IPhone, is similar to Depression CBT.

MoodKit was rated highly on several sites. It has a mood tracking feature and suggestions to improve mood as well as a thought checker to monitor mood.  However, it isn’t free.  It costs $4.99 to download.

None of these apps are appropriate for use alone when you are suffering from severe depression and suicidal thoughts.  You need to be in a formal, face-to face treatment, but the reality is that your therapist can’t be with you 24 hours per day. These apps can be helpful between sessions.

One of the better apps for addiction is Addicaid. It’s free. It has a check-in where you can disclose whether or not you used that day. Either way, you can post and get support from others. It has 12 educational sessions on various recovery topics. You can track your progress, get information on location of meetings and communicate with friends. There is a resource section with hotline numbers.

As I said before, you have to spend some time exploring these apps and getting to know how they work in order to really be able to use them quickly and efficiently.  There are others available. If you google mental health apps or addiction apps, you will come up with more.

So if you have a smart phone, utilize it as an aide in your recovery.

It’s National Recovery Month

2016-recovery-month-logo

 

September is National Recovery Month.   It’s sponsored annually by the government agency SAMHSA (Substance Abuse Mental Health Services Administration).  National Recovery Month celebrates recovery from mental illness and addiction.

How do we define Recovery? SAMHSA has identified four dimensions of Recovery: 1. Health, 2. Home, 3. Purpose, 4. Community.  The ability to manage one’s disease symptoms by making healthy choices with regard to diet, taking medications as prescribed, and abstaining from substances and activities that do not promote well- being fall within the health dimension.

The home dimension emphasizes the importance of a safe and healthy place to live for recovery to take place. SAMSHA defines purpose as “Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.”1  

Last of all, the community dimension speaks to the importance of having a support system consisting of family and friends that provide love and hope.

Notice that the SAMHSA definition of recovery doesn’t say anything about being “normal.” We can’t define normal. People who recover from a serious mental illness or addiction are usually changed in significant ways.  Recovery doesn’t require the person to be exactly as they were. You can’t go through the experience of dealing with a mental illness or addiction without becoming an emotionally deeper, stronger person. It also doesn’t require that the person be totally free of the illness.   People with mental illness and/or addiction (you can have both) are always vulnerable. I particularly like the SAMHSA definition of the health dimension – the ability to manage symptoms by making good choices, not necessarily to be totally without symptoms.

Many people, with and without serious illness, struggle with finding meaning and purpose in life. I like the SAMHSA examples of purpose – having meaningful daily activities such as a job, caretaking, volunteering, being creative.  Living life as best you can meets the definition of purpose in my opinion.

People with mental illness and/or addiction can recover.  If you know someone working to recover, the most important thing you can give them is hope.

 

Check out the resources on recoverymonth.gov

 

http://www.facebook.com/RecoveryMonth

http://www.youtube.com/RecoveryMonth

http://www.twitter.com/RecoveryMont

 

1 SAMHSA’s Working Definition of Recovery, download PDF at store.samhsa.gov.

 

 

Suboxone: Just Another Addiction?

I heard recently from a friend who attended a continuing education update on suboxone for non-physicians that the addiction counsellors who were there spent the entire session trashing suboxone.  I’m guessing they didn’t learn much. I’m not sure what role the moderator played, but apparently the trashing went on without anyone speaking up for the other side.  So, as a prescriber of suboxone, I’m going to speak up for the other side.

When I hear people criticize suboxone, it is usually based on opinion.  I see addiction, especially opiate addiction, as a medical illness that affects the brain.  I see many of the choices that addicts make as a result of this brain dysfunction.  What often appears to be a choice, is not really a free-will choice. It’s fueled by craving, fear of withdrawal, and for people who have failed many treatments, a sense of hopelessness. We don’t treat other medical illnesses based on opinion. We look at the research.

These are the most common criticisms that I hear about suboxone.

  1. It’s just as bad as the heroin. It’s just another opiate, replacing one opiate with another. You’ve got to be kidding me. You really think that suboxone, an FDA approved medication, is just as bad as heroin? Honestly, I have heard people, even addiction therapists, say this. Suboxone is a partial–opiate agonist, meaning that it binds to opiate receptors, but does not have the full effect of an opiate such as morphine or heroin. People who take suboxone don’t crave opiates because their opiate receptors are occupied, but they don’t feel high.  My patients tell me that they feel “normal.” They feel clear cognitively.
  2. It can be abused just like heroin.  Yes, it can be abused. So can gabapentin, amitriptyline, tramadol, Wellbutrin, Prozac, and many other legally prescribed medications. Oh, and let’s not forget the opiates that are legally prescribed for pain. Because suboxone is a partial–opiate agonist, you have to work hard to abuse it. Most true opiate addicts don’t’ want to bother abusing suboxone because they don’t get the kind of high that they get with the stronger stuff. It’s too much trouble. Plus, the effect of suboxone plateaus after a certain amount. In other words, you can take more but you won’t get any more benefit. This is in contrast to pure opiates which continue to exert effect (mainly getting high) as the dose goes up. This is why addicts take so much of the pure opiates that respiratory suppression occurs and death ensues. Most people who have overdosed on suboxone have other drugs in their system as well, usually benzodiazepines (valium, xanax, ativan). It’s hard to overdose on suboxone alone, but not impossible.  If people are determined to overdose, they will find a way to do it, whether it’s suboxone or something else.
  3. That doctor kept my family member on it for 7 years. Yep, that’s another common complaint. Family members or anti-suboxone therapists feel that patients should be off of suboxone in a few months. It’s the should word again. When suboxone first came out, the thinking was that people could be tapered off in 6-12 months. However, studies have shown that some of those people who were tapered off quickly, relapsed. It seems that people who stayed on it longer, did better. The dose can and should be decreased over time, but it may be that some people manage better with a small amount long-term.  So I would say that if your family member or client is doing well, working, managing family life, contributing in a positive way to society, why are you worried about whether or not they take a pill to treat their addiction? So they’ve been on it for 7 years, or 8 years or 10 years.  We need to accept that this is a chronic, serious, tough to beat illness.
  4. The withdrawal from suboxone is worse than heroin. That’s why you work with a physician who understands suboxone.  It has to be tapered slowly. Some people can taper faster than others. Withdrawal symptoms can be treated. Why rush?   If the client just stops suddenly (which sometimes happens when friends, family, or therapists hassle them about being on suboxone), there will be withdrawal symptoms.
  5. Addicts can do it without medication if they are really motivated. This one really gets me. So that means that if someone fails a treatment, it’s their fault?? That’s called blame the patient when the treatment doesn’t work. Yes, many people can do it without using medication and more power to them. But what about the ones who can’t? Are we to just chalk it up to their lack of commitment? In medicine, if someone fails treatment, we change the treatment, we don’t’ just wave them off as unmotivated. People who have been able to conquer their addiction without medication tend to be the loudest proponents of the “my way is the only correct way to do this” approach. So is there really only one way to achieve sobriety? I just don’t think so.  One belief that underlies this idea that all addicts should be able to get sober on their own without medication is that addiction is just the product of a weak will. PEOPLE, it’s not that simple. READ the studies, look at the science of addiction. If it were really that simple, I think we would have more sober people and fewer deaths from opiate addiction.
  6. If they are taking medication, they aren’t really sober. This is often the AA/NA stance. That’s why many patients on suboxone either don’t go to self-help groups, or they go but don’t reveal that they are on suboxone. That’s too bad. AA and NA have a lot to offer opiate addicts on suboxone. They still need contact with people who are sober, people who have been through what they have. Sometimes they have more than one addiction.  Too bad these groups can’t get past the idea that some people benefit from taking medication for their illness. I often want to ask people who complain about suboxone if they would advise people with diabetes or hypertension to go off their meds because they should be able to control their blood sugar or blood pressure on their own.  By the way, I don’t hear a lot of complaints about people taking the approved medications for alcohol dependence – disulfiram, ReVia, acamprosate.

People who are on suboxone are struggling to get their lives back together. They don’t need to be sabotaged by others who feel that there is only one right way to get clean, their way.  Suboxone is not magic.  Most people on suboxone are also in therapy.  Before you criticize somebody on suboxone, think about whether you would rather have them on a medication that helps them maintain sobriety or at risk of relapse because they have failed other treatments. Would you rather have them alive or dead?

This is one study looking at suboxone versus methadone versus placebo. There are many others published. Go to PubMed (The National Library of Medicine) and search suboxone or buprenorphine. Base your recommendations about suboxone on research rather than opinion.

 

Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD002207.

Drunkorexia – Is Your Child At Risk?

There is a new trend on college campuses.  While college students are known for risky behaviors, this one is very hazardous to health. It’s called drunkorexia. Dr. Dipali Rinker, a research assistant in the department of neurology at the University of Houston, reported on a study that she conducted at the Research Society on Alcoholism meeting in New Orleans on June 30, 2016. The phenomenon of intoxication on an empty stomach is not new, but the extreme to which some college students are taking it is very concerning.   According to the findings from Rinker’s study, these students engage in one or more of the following behaviors before or after drinking: excessive exercise, binging and /or purging, or extreme calorie restriction. The main purpose of the behaviors is to enhance the euphoria from drinking, though some students reported that they also wanted to decrease calories from the alcohol. Rinker reports that in her study, both men and women were equally likely to engage in drunkorexic behaviors to reduce calories from alcohol.  She noted that college women who drank more had more bulimic behaviors and more problems with alcohol as a result of those behaviors.

 

A similar study was reported by Science News (sciencedaily.com) in October of 2011. That study was conducted at the University of Missouri and was reported by Victoria Osborne, assistant professor of social work and public health. She and her colleagues found that 16% of students surveyed had restricted calories in order to save them for drinking alcohol.  In her study, three times more women than men reported these behaviors.  The motivation for drunkorexia in this study included getting drunk more quickly, preventing weight gain and saving money for purchase of alcohol rather than food.

 

Combining excessive drinking with lack of nutrition can lead to both short-term and long –term consequences.  Drinking alcohol on an empty stomach leads to intoxication much more quickly. College students are particularly vulnerable to making bad decisions when very intoxicated. They may be new to college, seeking social approval, feeling both insecure and exhilarated at new-found freedom. The impairment that comes from alcohol intoxication can lead to sexual victimization, violence (as victim or perpetrator), difficulty academically, or life-threatening alcohol poisoning.  For students who came to college with a history of eating disorder issues or substance abuse problems, this combines the two and adds another layer of dangerousness.

 

Chronic alcohol use can result in nutritional deficiencies, especially deficits in folate and thiamine. Though the study subjects were not specifically tested for nutritional deficiencies, it stands to reason that this could be an issue when you combine poor nutrition with excessive drinking, even if it’s binge drinking. Thiamine is important in memory, cognition and muscle coordination. Folate is important in the development of new cells. It is extremely important during pregnancy because low folate can cause neurological birth deficits, especially spina bifida. Of course, college women are definitely of child bearing age, and may not always recognize that they are pregnant immediately. College students are not immune from other chronic diseases such as diabetes, hypertension, and seizures. Excessive drinking can increase the likelihood of seizures especially in someone who already has a seizure disorder. Of course calorie restriction and poor eating habits resulting in poorly controlled blood sugar increase the chances of diabetic complications such as neuropathy and vision problems.

 

So, as a parent, you may be wondering what the take-home message is here. Can anything be done to prevent your child from participating in this behavior?  Your input as a parent can make a difference. Here are some suggestions for the pre-college discussion.

 

  1. Know your child. Has your child had social anxiety, some self esteem-issues? Allow your child to discuss anxiety about adjusting at college. Help your child come up with some ideas for meeting people.  If your child is shy, practice some conversational techniques that may work for them.
  2. Ask your child directly how her friends feel about alcohol and drugs. Sometimes kids are more willing to tell you how their friends feel than how they feel. But chances are, they feel the same way.
  3. Talk with your child about how she might handle some specific scenarios when alcohol is offered. Help her come up with some responses and actions that will work for her when she needs them.
  4. Work on problem solving. If he does find himself in a bad situation, what can he do? Keep communication open. If he is being pressured to drink or is drinking, he needs to be able to talk to you about it without fear.
  5. Don’t be complacent if your child has tried alcohol or drugs during high school and seemingly “learned their lesson.” You may think that the novelty has worn off, and they are not as likely to go overboard, but that isn’t true. These kids are more likely to increase their use of drugs and alcohol in college.
  6. Be aware of how things are going once they get to college. Call and visit. If grades start to deteriorate, they seem distant, they seem tired or speech seems slurred, ask questions.
  7. Be honest with yourself about your own drinking and drug use. You are the role model. If you have a problem, your kids are more vulnerable because of genetic and environmental influences.

 

If you think you may have a problem yourself, start there. You really can’t have the kind of open communication that you desire with your pre-college child if you have not dealt with your own substance use.   If you aren’t sure whether you have a problem, get an assessment from an addiction professional. If you know you have a problem, get treatment. Check out the American Society of Addiction Medicine website (asam.org). Click on Resources and then Find a Doctor.

University of Missouri-Columbia. (2011, October 17). ‘Drunkorexia:’ A recipe for disaster. ScienceDaily. Retrieved July 4, 2016 from www.sciencedaily.com/releases/2011/10/111017171506.htm.

Research Society on Alcoholism. (2016, June 27). Drunkorexia 101: Increasing Alcohol’s Effects Through Diet and Exercise Behaviors. ScienceDaily. Retrieved July 4, 2016 from www.sciencedaily.com/releases/2016/06/160627100223.htm

 

 

 

Mindfulness Based Stress Reduction: Keeping the Brain in Shape

Mindfulness Based Stress Reduction at Work.

Mindfulness Based Stress Reduction at Work.

Mindfulness is one of those terms that seems self explanatory, but it really isn’t. We all have minds, so aren’t we all mindful?  Probably not.  The concept of mindfulness is just entering the portal of mainstream medicine. For many years, mindfulness meditation (also known as Mindfulness Based Stress Reduction, MBSR) was thought of as something akin to yoga, practiced mainly by “health nuts” who had the time to sit for hours in a trance, and mainly appealing to people who were interested in Eastern religions. It seemed “experience distant” to most people, meaning that it was interesting but not really relevant to their lives.

First of all, let’s define mindfulness. Jon Kabat-Zinn, who is credited with bringing mindfulness meditation into mainstream medicine, says that mindfulness is the awareness that arises through paying attention on purpose in the present moment nonjudgmentally.  Many people think that mindfulness meditation is about clearing the mind, having a blank mind. That is not the case.   Mindfulness Based Stress Reduction usually begins by sitting quietly and focusing on the breathing. As thoughts begin to intrude, and they will, they aren’t pushed away.  Attention is gently brought back to the present by focusing on breathing.  This back and forth between mind wandering and bringing back attention to the present occurs over and over again for most people, especially when beginning MBSR. The key is that thoughts and/or bodily sensations are not judged as good or bad; they are simply observed.  For example, while engaged in MBSR, you might experience some discomfort, maybe some back pain or a sensation of hunger. You experience that sensation, but you don’t try to resist it. You don’t try to judge it as good or bad. You might be curious about it. You simply experience it. You try to develop the ability to observe your sensations objectively. Most people focus on their breathing during the meditation, but some find it easier to listen to a sound in the back ground or some quiet music.  I will discuss more about the actual practice of mindfulness in the next blog.

What is the purpose of this exercise anyway?   There are actually two components to bodily sensations and emotions.  One component is the actual physical sensation or the emotion, while the other component is our judgment of it, how we perceive it. Do we perceive it as bad, good, pleasurable, noxious?  How we perceive it is really what determines how we respond.  Pain is deemed to be bad because we judge it to be. Kabat-Zinn would say that learning to stand back and observe emotions and sensations more objectively makes them more tolerable.  We have a tendency, understandably, to fight what we see as negative emotions. This simply activates the sympathetic nervous system which increases blood pressure, heart rate, tenses muscles, etc. That is our fight/flight response. But though adaptive in some situations, constantly being in fight/flight mode takes its toll on the body.

Kabat-Zinn and MBSR advocates are not suggesting that we need to learn to like pain or anxiety. But practicing MBSR can keep us from being so overwhelmed by intense sensations or emotions. It’s an acceptance of our present state without letting ourselves go down the slippery slope of negativisms such as “this will ruin my day,” or “I’ll never be free of this pain.”  We are so accustomed to thinking through our day as we drive to work and imagining worst case scenarios.  The concept of simply focusing attention on the present is rather foreign to most of us. How much of the present do we miss by constantly focusing on the past or future?

So far, recent articles have shown that mindfulness training can reduce stress during a period of high workload on military helicopters (Meland et. al. in the International Journal of Aviation Psychology, Oct. 2015), decrease fatigue, anxiety and mood symptoms in breast cancer survivors (Carlson et. al in Psychooncology, May 2016), and decrease pain intensity, pain catastrophizing, interference of pain in daily life and depression in cancer patients (Poulin et. al., Supportive Care of Cancer, May 2016).  There seems to be evidence that MBSR can help patients with addiction by modulating responses to environmental cues that instigate craving.  There is even evidence that MBSR can slow progression of Alzheimer’s Disease (Quintana-Hernandez et. al. Journal of Alzheimer’s Disease, 2015) and improve some problems with memory loss.  It seems to exercise the brain and keep it free of unnecessary debris.

In my next blog, I’ll explain more about the mechanics of Mindfulness Based Stress Reduction, including some tips on getting started.  I’ve included a YouTube video that explains more about mindfulness based stress reduction.    There are numerous YouTube videos on this topic including several by Jon Kabat-Zinn himself.

Love and Addiction

The short answer is – the same way you love everyone else. Love is not always a two-way street.  Have you ever loved someone who desperately needed your love but seemed to reject it? People with addiction are not easy to love because they do unlovable things.    Most of us have struggled with this in one way or another. It’s almost impossible to go through life without experiencing the effects of someone’s addiction.  There are non-substance addictions such as internet, gambling, shopping, even perhaps cell phone.  Some of these addictions may seem more innocuous, less disruptive than, say, heroin addiction. But they are still addictions.

Though I do believe that there is a strong biological component to addiction,  and it resembles other medical illnesses in many ways,  people with addictive disorders have problematic behaviors that affect other people. They steal, they lie, they end up in jail sometimes, they get sick, they become homeless, they need money, they lose jobs. Families and friends have to deal with that. Diabetics may not follow their diet or they may play passive-aggressive games with their medication, but they usually don’t steal money or end up homeless.

I find that people with addiction who grew up in a household surrounded by addiction have a double whammy. They have the genetic predisposition, but they also missed the benefit of good role-modelling.  Good parenting (though no parents are ever perfect) is essential for the development of things like empathy, ability to delay gratification, frustration tolerance, etc.  So when these people stop using drugs, they still don’t function that well because they missed some important developmental tasks.  They need a lot of therapy and support to maintain sobriety.

So what are friends and family to do when they have a child, spouse, friend who is actively using and seems to be skyrocketing downward?  The pat answer has always been “don’t enable them.” But what does that really mean? Assuming that you’ve tried to get them in treatment and they’ve refused, what next?

Refusing to enable someone has usually meant letting them hit rock bottom. It means never giving them money, which they will surely use for drugs rather than food, never allowing them to stay with you as long as they are using, perhaps completely stopping communication with them.  The theory is that this may push them to get treatment. Sometimes it does, sometimes it doesn’t. Sometimes they die.

I wonder how I would handle it if my child suffered from a drug addiction.  Could I really cut them off totally? I’m not sure that I could.   You can always hope that your loved one finally agrees to treatment, but I’m not convinced that totally cutting them off is any guarantee.  However, I realize that sometimes families may need to do this to maintain their own sanity.

How can you provide some basic support for the addicted person, yet not enable their drug addiction? I don’t have easy answers to that.  I have worked with some families who provide food (not money for food) and a place to live – that’s it. No money and no transportation except to doctor’s appointments.   Sometimes they’ve come to that compromise after trying harsher approaches such as kicking the person out.  However, if the addicted person is violent or negatively affecting other people in the family, particularly younger children, then they really can’t be in the home.

Al-Anon is a good resource for families of people with addiction.  It is helpful to talk with other families who are going through the same thing.   Families dealing with addiction often tend to isolate. Don’t do it. It isn’t helpful in the long run.

People with addiction are masters at making their families and friends feel guilty for not helping them – in the way they want help.  Sometimes you have to love someone from afar.  You remind them that you believe that a better life is possible, that you are willing to help them, that you love them. You offer what you think they need, not what they think they need. If they don’t accept it, that is their choice.  It may be a choice fueled by their addiction, but in our society today it is still their choice.

 

 

 

 

 

 

 

What is Recovery?

Does abstinence equal recovery? Certainly sobriety is the goal of most people who enter treatment.  Most people celebrate their years of sobriety and consider that a marker of recovery.  Certainly, length of sober time is something to be celebrated. But is it an end in itself?

Recently, the Substance Abuse Mental Health Services Administration published an advisory on the use of buprenorphine in the treatment of opiate use disorder (the new term for opiate addiction).   A quote from Thomas McLellan and William White, addiction experts in England, was included in the advisory. It states in part “Neither medication-assisted treatment of opioid addiction nor the cessation of such treatment by itself constitutes recovery. Recovery status instead hinges on broader achievements in health and social functioning – with or without medication support. “

This isn’t a negative view of medication assisted treatment for opioid addiction. On the contrary, the advisory supports the safety and efficacy of medication assisted treatment (primarily use of buprenorphine/naloxone preparations) when used in a treatment setting with appropriate monitoring. The quote simply points out that taking medication alone does not really constitute recovery.  I think that can be generalized to suggest that abstinence alone does not really constitute true recovery.

So what is recovery? Have you known someone who achieved abstinence but still seemed to have the same lifestyle they had before sobriety? Chaotic relationships, poor judgment, inability to hold a job – all symptoms of failure to really grow emotionally.

In my opinion, people who really recover from addiction have been able to finally figure out what their values are, what is important to them in the big picture of life. They get beyond daily frustrations, minor setbacks, dysfunctional family relationships because they have bigger goals.

They begin to think about what they believe in, what is important to them, and what contribution they want to make to mankind. Their worldview broadens beyond their day to day experience.

This may not be easy to achieve, especially for people who grew up in very dysfunctional families where the focus was on day-to –day survival. They haven’t had the luxury of thinking about life beyond their own daily existence, especially if they are still involved with their family.

That is really where therapy, sponsors, and group support can make a big difference.   That is why most good medication assisted treatment programs insist on therapy along with the medication.

Certainly abstinence is a key element in recovery. You can’t have recovery without it. But true recovery is much more than that.   What do you think constitutes recovery?

Alcohol Use Disorder – New Name, Old Problem

Opiate addiction has been in the spotlight recently. We’ve all seen the statistics.  New cases of HIV are popping up daily in seemingly small, sleepy little towns all over the country. While addiction to pain pills and heroin is a life-threatening illness, alcohol misuse is actually more devastating in terms of the number of deaths related to it.  According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 88,000 people die from alcohol related causes yearly. It is the fourth leading preventable cause of death in the US (National Center for Statistics and Analysis, 2015). In 2014, alcohol-impaired driving accounted for 31% of overall driving fatalities (Stahre, M.  in Preventing Chronic Disease, 2014).  Alcohol misuse takes a toll on health as well.  Global statistics reveal that it is the first leading risk factor for premature death in people between 15 and 49.  In the 20-35 year age group, 25 percent of total deaths are attributable to alcohol misuse (World Health Organization 2015).

The current diagnostic label for problematic drinking is alcohol use disorder. How do you know whether you have an alcohol use disorder?  The bottom line is that if you wonder whether you have a problem, you probably do. There are several screening tools that clinicians use to diagnose problem drinking, and I’ll include one at the end of this blog. However, ask yourself whether anyone has expressed concern about your drinking, whether you need a drink to get going in the morning, whether alcohol has caused you to lose a job or a relationship, or contributed to a health problem. These are all red flags that could indicate that you have a problem.

There are some guidelines about what constitutes moderate and problem drinking.  According to NIAAA, moderate alcohol consumption is defined as up to one drink per day for women and 2 drinks per day for men.   Binge drinking is defined by the Substance Abuse Mental Health Services Administration (SAMHSA) as drinking 5 or more drinks on the same occasion at least one day out of the last 30 days.  SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.  However, in order to really understand these guidelines, it is important to understand how a standard drink is measured. A standard drink is 12 fl. oz. of regular beer, 8-9 oz. of malt liquor, 5 fl. oz. of table wine, or a 1.5 oz. shot of 80 proof spirits (whiskey, gin, vodka, rum, etc.). So if you drink a 24 oz. tall boy, you really have had two standard drinks.

It is true that moderate levels of alcohol have been shown to be beneficial. For example, moderate alcohol consumption decreases risk of heart disease and ischemic stroke (stroke due to blocked arteries and reduced blood flow to brain), and diabetes.  But again, these studies are talking about MODERATE drinking as measured by the STANDARD drink.

I mentioned a lot of statistics in the first paragraph. However, I was most surprised by the statistics regarding treatment. Only about 8.9 percent of adults who needed treatment (9.8 percent of men and 7.4 percent of women) received it. This could have been due to refusal to get treatment, lack of available treatment, or lack of financial resources to get treatment. It’s a rather abysmal statistic, however you look at it.  There is still stigma about admitting to an alcohol problem. I believe it is decreasing.  There are new treatments available that have a better track record as far as treating alcohol use disorder.   Talk to your primary care doctor.  For more information, check out the following:

www.niaaa.nih.gov

www.samhsa.gov

Check out the AUDIT. If you score 8 or above, you may be a problem drinker.

AUDIT