Archives for February, 2012
A growing body of research suggests that food can be as addictive as drugs like cocaine and nicotine. In addition to being unhealthy, processed, sugary, wheat-based, fatty and salty, foods affect the reward circuitry in the brain, resulting in compulsive eating despite the well-known risks of heart disease, diabetes, high blood pressure, high cholesterol, cancer and other negative consequences. Late Princeton psychologist Dr. Bartley Hoebel hypothesized that both drugs and sugar are governed by three characteristic phases of addiction: binge, withdrawal, and preoccupation. Like drugs, studies show that people can develop a tolerance to sugar, needing more and more to feel pleasure, and experience withdrawal-like symptoms when cut off from sugar. Interestingly, drugs we use to block opiate receptors in the brain, such as naltrexone and topiramate, also reduce cravings for fatty and sugary foods. Other studies have revealed some interesting findings about food addiction: • A Yale study found that the brain activity of women with three or more symptoms of food addiction who viewed images of and then drank a chocolate milkshake was similar to drug addicts. Just as drug addicts’ brains light up when viewing drugs or drug paraphernalia, food addicts’ brains light up in the areas governing pleasure and reward when looking at high-fat foods and show reduced activity in regions involved with self-control when actually consuming those foods.
Happiness is a feeling most of us are quick to embrace. But when feelings of sadness, anger, stress or frustration arise, it can be tempting to believe that feeling nothing would be better than feeling down. Whether it’s the laws of nature or the age-old principle of yin and yang, it seems that we are required to experience both extremes on the emotional spectrum. Human beings are social creatures that need feelings to survive. Emotions connect us to other people and help us interpret, respond to and learn from our environment. It is our emotions that compel us to be in relationships, raise families and escape from danger. When difficulties arise in our relationships, or memories of a painful childhood or troubling experience surface, it is understandable to think that numbing those feelings would bring relief. When someone is pushed to the edge of what they can tolerate, the choice may come down to suicide or emotional escape. And drugs are a quick, powerful way to disappear. But numbing painful feelings with drugs comes at a price. In addition to drowning the difficult emotions, the positive ones begin to fade. An even greater risk is addiction, which comes with its own artificially manufactured highs and lows. Over time, drug users lose touch with their emotions and, in doing so, destroy their relationships with others and themselves. The easy accessibility and perceived safety of prescription drugs have intensified the risks of addiction. Ordinary people with families and jobs are finding themselves hooked on medications. In some cases, the pills were originally prescribed for a legitimate medical purpose, such as to treat the pain of an injury or accident, and the individual became dependent over time. There is also a growing population that sets out to abuse prescription medications for their euphoric, stimulating or relaxing effects.
I remember driving past a church one evening with a colleague. A large group of people stood out front, shrouded in an impressive cloud of cigarette smoke. “AA meeting,” my colleague remarked. He didn’t actually know this for a fact, but this is one of those iconic images of recovering alcoholics: coffee cup clutched in one hand, cigarette in the other. Treatment programs don’t usually address nicotine addiction; they say it is just too much to take on in the early weeks or months of recovery. It is probably the most common cross-addiction. People who quit smoking years ago will start up within days of quitting drinking, looking for something to make them feel better. Recovery from addiction can feel like a game of whac-a-mole™, that classic carnival game where you mallet a mole as it pops up from its hidey hole, only to have one pop up from another hole. Whack away; there is always another mole taunting you from another hole. Cross-addictions are nothing new, but the fact that treatment centers are now addressing them during the first 30 days of recovery is.
Anyone who has managed to avoid addiction (whether to drugs, work, sex, food, or some other substance or behavior) is fortunate indeed. But those who have not may not be as unlucky as they think. In drug rehab, addicts learn life lessons and skills that many people don’t learn until much later in life, if ever. As a result, I believe people in addiction recovery often lead happier, more meaningful lives than the general population (with noted exceptions for those who continue with diseased thinking and behaviors regardless of what they learned in drug rehab). Here are some of the possible reasons for this turnaround:
#1 Recovering addicts are grateful to be alive.Gratitude is a recurring theme in 12-Step recovery. Early on, addicts are advised to simplify their lives, making their recovery their primary focus. This clears space for the things that matter most – personal growth, health and family – and drives many to make long-needed changes in their careers, relationships and lifestyle.
Some relapse triggers, such as stress, job loss, isolation, the death of a loved one, and other distressing events or feelings, get a lot of attention during treatment, and rightly so. But sometimes it’s the happy moments (or the seemingly neutral ones) that sneak up and trigger a return to drug use. Here are five triggers that often take unsuspecting recoverees by surprise: #1 Sex and Relationships An oft-repeated (and oft-ignored) cardinal rule of early recovery is to avoid dating for at least the first year. This advice is not intended to punish, but to give the recovering addict time to focus internally – to figure out who they are, what they want and how to cope without using drugs or alcohol – before trying to be a source of support for someone else. At a time when recovering addicts are most likely to want a relationship and least likely to be prepared for one, they are at high risk of falling into the familiar pattern of looking outside of themselves to fulfill emotional needs, escape or relieve stress. Some people rely on the “high” of a new relationship as a substitute for drugs or alcohol. Cross addictions to sex, love, romance or relationships are a major cause of relapse among the newly sober.
In 2011 a group of physicians descended on Capitol Hill to ask congress to help them fight prescription drug abuse. How? Finally require all health care professionals get real training in prescribing addictive drugs, recognizing signs of addiction, and identifying problematic patterns of use. Most physicians receive little or no training regarding substance abuse and the use of controlled substances that have the potential for addiction. While there are many doctors who prescribe these powerful drugs responsibly, and these drugs are often critically important when used as intended (usually very short-term use or on an as-needed basis), better education will help them recognize drug-seeking behavior and train them to evaluate and refer these patients to treatment the same way they do when they see high blood sugar or blood pressure.
Call it human nature. When something goes wrong, we look for someone to blame. When a child gets in trouble, they are quick to point the finger at a sibling. When a product malfunctions, we sue the manufacturer. So it isn’t surprising that “Pharmageddon” would spark its own type of blame game. Even though the U.S. government’s War on Drugs started more than 40 years ago, in many ways it has been reborn in new formats. Just as the problem of illegal drug abuse has been met by law enforcement with punitive penalties for nonviolent drug offenders, the prescription drug epidemic has provoked its own type of witch hunt. Who is responsible? Who can be punished for allowing the nonmedical use of painkillers to take second place as the most prevalent form of drug use in America, even as the War on Drugs rages on? In the past decade, there has been a 400 percent increase in admissions to drug rehabilitation centers for addictions to prescription pain relievers. We have seen a fivefold increase in hospitalizations and a fourfold increase in overdose deaths related to prescription drugs. Teenagers who used to experiment with illicit drugs like cocaine, meth or heroin now prefer prescription drugs like Vicodin and OxyContin. We are hearing the alarm bells about prescription drug abuse, but the knee-jerk reaction has been punitive – more law enforcement, monitoring doctors and catching people filling too many prescriptions. Is this the new War on Drugs?
Rage. Instability. Mood swings. Impulsivity. These characteristics make people with borderline personality disorder (BPD) prone to substance abuse as well as over-spending, promiscuity, eating disorders and other compulsive behaviors. In fact, studies suggest that 50 to 70 percent of those with BPD also have a co-occurring substance use disorder. Addicts with co-occurring borderline personality disorder are known as some of the most difficult patients to treat. Here are a few of the most common challenges, along with insights into the most effective research-based treatments:
Treatment ComplianceAddicts with BPD have been described as both treatment demanding and treatment resistant. Research shows more positive outcomes the longer an addict with BPD stays in treatment, yet keeping them in treatment is no easy task. In a study of patients in a detox program, those with BPD were significantly more likely to have an unplanned discharge than those without BPD. While a number of treatments have proven effective for BPD, therapies for BPD patients with co-occurring substance abuse are less established. Studies suggest that the most promising treatments include dialectical behavior therapy, cognitive-behavioral therapy and psychodynamic approaches. A combination of support and management from an experienced dual diagnosis treatment center can improve retention rates, along with ongoing involvement in self-help groups such as AA and NA.
Human beings are social creatures. Although we may not always like it, we need each other. For recovering addicts, who likely lost a lot of old drug-using friends when they got sober, this can be a particularly painful realization. Without conscious effort, early recovery can be a lonely time. This is where one tried and true component of addiction treatment – a strong social support system – can bolster long-term recovery. A social network can keep recovering addicts invested in their recovery program even if they lose motivation, get discouraged, or become complacent or over-confident. Research suggests that social relationships provide emotional support, a sense of belonging and stress relief. While higher levels of social connection improve quality of life, lower levels have been linked to relapse.
In the field of addiction treatment, some of the most tragic stories are those of high-functioning addicts. The friends, neighbors, relatives and co-workers you look up to – envy even – for their beautiful homes, loving children and successful careers may be dealing with a secret addiction that is destroying them from the inside out. How long do you think it would take to identify the signs of addiction in someone close to you? Most people assume they’d perceive a problem rather quickly, keeping an eye out for major life consequences such as job loss or destroyed relationships. But according to a 2007 study by the National Institute on Alcohol Abuse and Alcoholism, only 9 percent of alcoholics fit this stereotype. The majority of addicts are high-functioning – high-power executives, surgeons in the operating room, successful professionals, hard-working stay-at-home moms and others you may not suspect even if you know them intimately over a long period of time. High-functioning addicts are masters of disguise whose struggles with drugs and alcohol may go unnoticed for years, often with increasingly severe consequences. Here are a few ways to unmask the high-functioning addict in your life: