Stop it – You’re not addicted to “The Bachelor”

I hear people talking about their addictions all the time. If they know that I’m an addiction expert it’s even worse…

“I’m addicted to ‘The Bachelor’!” one girl exclaimed to me once. Others have “confessed” more standard addictions to their Blackberry, chocolate, or even frozen yogurt. I’m usually nice to the the guilty parties, but this stuff makes me mad. Why?

Addiction doesn’t mean really liking something

For one thing, this attitude trivializes addiction itself – It creates the belief that addiction is incredibly common and is just not that big of a deal. My Bachelor “Addicted” friend isn’t losing her job, her house, or even sleep over her terrible affliction and yet she has no problem putting it right there on the mantle next to a good old heroin habit. It’s not right. The more we trivialize mental health disorders, which are difficult enough to diagnose, the more of a misunderstanding we create about their true impact. If every one of us is addicted to every thing we find ourselves engaging in, or caring about, a little more than we consider healthy than all those people who keep telling me that “everyone in the world is addicted to something” might just be right.

They’re not.

A very small percentage of us actually meet criteria for dependence. When you talk about the chronically relapsing addicts, the one we all picture when the word comes up, the percentages are even lower. The loss of effect (tolerance) and the withdrawal symptoms when we stop using; the repeated negative consequences, loss of interest in other activities and the desire and unsuccessful attempts to quit are all part of the picture. The more symptoms, the more devastating the impact. It’s not about really liking something… It’s not AT ALL about that.

Addiction is not about doing something a lot

Every time I’ve written about what defines addiction I’ve made this point – Addiction is absolutely NOT about quantity.

I’m not saying it’s impossible for someone to be addicted to watching “The Bachelor.” But someone who finds themselves watching 10 episodes in a row because one is just not satisfying is simply a big ol’ The Bachelor fan. But, if that same person is repeatedly late to work meetings or has skipped out on work altogether to watch The Bachelor marathons, or if they have promised their significant other that they’d stop and gave it a real shot knowing it was interfering with their relationship but just couldn’t do it… Show me that person and you’ll have shown me a real Bachelor addict. I’m guessing there aren’t a lot of them out there…

So stop telling everyone you’re addicted to your Blackberry and take responsibility for the fact that you keep turning to your email messages because you like the satisfaction of seeing a new message or being able to check the latest NFL score. Feel good about and embrace your love for crappy television without having to resort to an explanation that makes it seem like your finger uncontrollably hits the right channel button… You’re lying to us, you’re lying to yourself, and you’re making those with a real problem seem like idiots.

They’re not.

About Addiction: Addiction Treatment, distress, kids with drugs, and your brain

This week our wrap-up includes articles about addiction, sometimes in kids, and the stress that can often accompany them As usual, we’ll educate you in 30 seconds flat and give you a window to this week’s hot stories.

Addiction treatment access

Boston Globe – Read about the often sad reality of American soldiers who become addicted to medications prescribed to them during service by medical staff and are then left holding the tab when it comes time to pay. Hopefully this practice is a thing of the past now that TRICARE, the military’s heath-insurance provider is allowing for future claims.  This should speed up the process and reimburse addicted service members for the out-of-pocket costs they have previously owed when they were using these drugs.

Addiction Inbox– Check out Charlie Lloyd’s account of the devastating effect of drug addiction stigma on treatment seeking. If we want to help, and not simply reinforce, the problem we must focus on education about addiction and not scare tactics.

Youth and drugs/addiction

Fox News– A two year old Indonesian boy has finally kicked his habit of smoking two packs a cigarettes a day. The toddler apparently first obtained the cigarettes from his father and became addicted quickly. Gives a whole new meaning to starting early…

The Vancouver Sun– Lindsey Lohan has opened up about her addiction in an interview with Vanity Fair. Lindsay conducted this interview before she went to serve her jail sentence and admitted that her actions were irresponsible and that she is addicted to prescription pills. LiLo would like to put the past behind her and get her career back. Good luck.

UPI– A Hawaiian man is suing a video games creator claiming that it lead to an addiction that left him unable to bathe, eat, dress, or wake during the day. Smallwood claims he spent more than 20,000 hours on his addiction and believes that the game should issue a warning that it may cause addiction because Smallwood still has a “compulsive urge and need” to play the game.

Body, brain, (di)stress, and death

Psypost – Young adults who get fewer than eight hours of sleep have a greater risk of developing  psychological mental  distress as well as depression and anxiety. This distress increased 14% for each hour lost in a night’s sleep. Get those ZZZZZZZZ’s !!!

Neurodynamics – A great read if you want to learn about the way in which the brain responds to stress. The amygdala,  the hippocampus, and the prefrontal cortex all play important parts, and this article will help you understand why and how.

Time– Abstainers apparently have shorter life expectancies than moderate drinkers. While the effect is similar to the reduced life-span of heavy drinkers, it’s a quirky finding that keeps showing up. There are a slew of suggestions and interesting ideas if you follow this article all the way to the study itself. The bottom line – Light and moderate drinkers likely do better than abstainers or heavy drinkers (alcoholics?) in the long run, even when a whole bunch of other factors are accounted for.

Breaking the cycles-What would you do if a police officer pulled you over and arrested you for driving under the influence if you BAC was not .08? This is a reality and the reason for the DUI is  the inability to drive a car with the same caution characteristic of a sober person. This inability to drive as carefully as a sober person is determined by the manner in which the car was driven, the physical signs and symptoms of the driver and the driver’s performance on field sobriety tests. This definitely give a new meaning to being careful when you have a few drinks and drive home.

“Addicted” – Recovered and Helping: The reality (tv) of addiction treatment.

With the success of shows like A&E’s Intervention and Celebrity Rehab with Dr. Drew, America has shown an almost insatiable appetite for television programs that deal with addiction. Whether this reflects the breadth and depth of the addiction problem in this country or a national appetite for tragedy and schadenfreude is open for debate, but regardless, TLC has now thrown its own hat into the ring with a new series, Addicted, that follows a trained family interventionist who is, herself, a recovering addict. Though the line between education and exploitation in such shows remains a debatable matter of personal opinion, it calls to our attention a crucial element in modern addiction treatment: the unique position of the recovering addict to make a positive difference in the lives of those still caught in the grip of dependency.

Hey, it’s what got me starting this website over three years ago.

Addicted on TLC – Addiction treatment reality

Kristina from the TLC show AddictedKristina Wandzilak, the main character of the TLC “Addicted” show, is a professional interventionist specializing in family-style interventions, targeted towards not only the addicts themselves but the families for whom having an addict as a family member has destabilized their lives and sense of control. The central philosophy of family-style intervention revolves around working not only with the addict but with the entire family to restore that feeling of control and healthy boundaries, after which, the theory goes, recovery of the chemically dependent individual can follow. Wandzilak’s faith in this style of addiction treatment is hard-earned; as a cocaine and methamphetamine addict, she cites her own mother’s ability to establish a firm boundary and “walk away” as the impetus for her to finally get clean.

Wanzilak’s story is a sadly common one. Falling in love with alcohol from her first drink at the age of 13, addicted to cocaine and methamphetamine by age 15, and in and out of treatment by 18, Kristina was clearly on the fast path to an early grave. Returning home after another escape from rehab, she was turned away at the door by her mother, a firm line she would later credit as the first step to her recovery. Though the next three years of her life would involve a continued spiral of cocaine and methamphetamine addiction, prostitution, and robbery, it was allegedly at a moment of complete rock bottom that her mother’s strength and grace in turning her away served as the inspiration for her to finally take control of her own life. After seeking her own addiction treatment, Kristina has now been sober since September 4, 1993 and calls this the greatest accomplishment of her life. In her words, she feels that if she helps families to embody the strength that her mother had in dealing with her, the addicts will be forced to “run into themselves” and thus find sobriety soon thereafter.

A note here – I’ve talked about the difference between positive reinforcement and punishment before, so I won’t go into it at length here, but I think it’s important to keep in mind the fine line between helping someone by keeping consistent boundaries and hurting them by refusing to help. With this show just starting, I really hope that this line is kep in mind and that the producers, and Kristina, don’t use it for ratings rather than helping those in need.

Where would addiction treatment be without recovered addicts?

The question stands- does Kristina Wanzilak’s or any other addict’s past with addiction make them more qualified to help those now suffering through the same issues? Many people feel that this is the case, including qualified specialists like Dr. Drew Pinsky, who takes most of the staff for his VH1 series Celebrity Rehab with Dr. Drew from a group of former addicts. Regulars on Celebrity Rehab with Dr Drew include technician Shelly Sprague and counselor (and program director of the Pasadena recovery center) Bob Forrest, both highly trained and qualified addiction specialists whose own experiences as addicts serves as a tool for understanding and gaining the trust of difficult patients, as well as promoting these people as living examples of the possibilities that await even the most seemingly hopeless cases. Sober houses are also overwhelmingly run by recovering addicts who can teach the newly sober a structured lifestyle and tricks to keeping focused on recovery. Our own Adi Jaffe, director of All About Addiction, is a recovering addict himself (check out his story on the Press tab). As we see recovering addicts step up to help those that remain trapped in a life of getting high, we are increasingly made aware of their unique ability to make a difference in lives that many had considered lost. Addicted on TLC is keeping that trend going.

Nevertheless, I don’t believe that having personal experience is necessary for becoming an addiction counselor or specialist, though it likely helps keep the motivation level high in a relatively stressful occupation. One thing is certain, seeing these examples of recovered addicts who are helping others is certain to do a lot of good to the addiction stigma I hate so much!

How doctors treat doctors with drug use problems: Addiction treatment that works

Physician Health Programs (PHP) are reporting an astonishing success rate when it comes to providing addiction treatment for addicted doctors:

  • Only about 20% of doctors ever test positive after being admitted to the program within a 5 year period.

  • More than 70% maintain their license and continue working within the same 5 year period.

These are the kind of addiction treatment results we want!

I’ve been saying for a long time that I believe in the theory promoted by Dr. McLellan, who until recently was the deputy-director of the Office of National Drug Control Policy (ONDCP). Doctor McLellan promotes a long-term view of addiction treatment, more like a chronic disease than anything that can be cured in a few visits (although this view only holds for some addicts).

I’ve also known for a while that the American Medical Association is supposed to be having great success at addiction treatment for addicted doctors. I’ve been meaning to contact someone at the AMA to find out how they did it. Now I don’t need to thanks to this recent bit of addiction research.

Addiction research on treatment for addicted doctors

A recent research article surveyed the vast majority of PHP’s and found that, not surprisingly, the things that we know work in addiction treatment do indeed produce results. The solution may not be easy, but it’s pretty simple:

  • Early detection and assessment brings the addicted doctor, their family members, colleagues, and employers together. Getting the problem out in the open early makes it easier to deal with than having to be secretive about it. The doctors get  an option, leave the profession or sign up for a 5 year treatment program to deal with their addiction.
  • Formal addiction treatment using the most appropriate and effective treatment centers In contrast to our criminal justice addiction pipeline, the majority of physicians (69%) receive 90 day residential treatment, while the rest receive intensive outpatient treatment. The PHPs also receive frequent status reports on each physician in treatment to assure adherence. To find treatment that works, use our Rehab-Finder.
  • Long-term support and monitoringAfter treatment, the physicians continue with aftercare that includes 12-step support, regular counseling meetings, and monitoring that includes random drug testing.

That’s it!  So simple yet so effective.

As addiction research continues to improve, I’m sure we’ll be able to bring these numbers up even higher than the 70% success rate currently reported. Still, you have to admit, 70% is amazing!!!

So if you want to know how to stop drinking and drugging, do like the doctors do and commit to long-term addiction treatment.

There are obvious differences between most addicts and the doctors in these programs (most people don’t have such a clear distinction between losing their livelihood and getting help), but the solution is most likely very similar.

More proof we need more money for addiction treatment:

We need to press our representatives to increase funding for addiction treatment and addiction research so that we can find the most efficient, yet effective, way to offer this kind of addiction treatment to the general population. By reducing the problems, we’d be able to cut into the $500 Billion a year drag addiction is putting on our economy. The effort will pay back for itself in no time.

Citation:

DuPont, R.L., Carr, G., Gendel, M., McLellan, A.T., Skipper, G.E. (2009). How are addicted physicians treated? A national survey of physician health programs. Journal of Substance Abuse Treatment, 37, 1-7.

Addicts’ brains depressed but normal users… normal.

A paper that’s about to be published in the journal Science has found at least part of the difference between the brains of addicted individuals and those that use recreationally.

The question as to why only some people get addicted to drugs has been a difficult one to answer. Still, there’s no doubt that only a relatively small fraction of those exposed to drugs develop the compulsive, often destructive pattern of use we associate with addiction. The pattern holds in animal research too – even though all the animals in an experiment get the same amount of drugs, delivered in the same way, only some of them develop addictive drug taking. It seems there’s something different about addicts’ brains, but what is it?

What’s different about addicts’ brains?

We’ve found quite a few things that differentiate addicts’ brains from those of normal research participants. These include lower density of a certain type of dopamine receptor (D2), reduced activity in specific brain parts like the OFC (orbitofrontal cortex) that are important in decision making and behavioral control. Still, if we start with what is supposed to be a pretty similar group of rats and give them all the same drug, for the same time, in the same amounts, why do only some get addicted?

This recent study found that a specific neuronal process called LTD (Long Term Depression), that is important in learning (or what we call plasticity) is suppressed in addicted animals for far longer than in animals that end up not not displaying addictive behavior. Even though all animals displayed this sort of deficiency in LTD right after learning to take drugs, only the addicted animals showed it when tested two months later.

Since the difference was seen in an area of addicts’ brains called the Nucleus Accumbens, a very important area for learning about rewards, it seems likely that it plays an important role in addicts’ inability to change their behavior after they’ve started using drugs. Past research has already identified this as a problem with something we call “reversal learning” but it seems we may have just found at least part of the mechanism.

Now we have to figure out why some animals show this sort of pattern and others don’t. Genetic variability seems like a good place to start here.

Citation:

F. Kasanetz, V. Deroche-Gamonet, N. Berson, E. Balado, M. Lafourcade, O. Manzoni, P. V. Piazza, Transition to addiction is associated with a persistent impairment in synaptic plasticity. Science 328, 1709–1712 (2010).

Is anonymity the final shame frontier in addiction?

I’m a drug addict and a sex addict, and as far as I’m concerned, staying anonymous let’s me remain buried in shame, and a double life, that keeps me always one step ahead of those close to me. Did I say too much? Did I give away my secrets? None of those  questions matter when everyone knows everything there is to know about you. For a disease couched in anxiety, obsessions, and compulsive behavior, there’s very little that can be more triggering.

The difficulty of confessing addiction

Obviously I’m not naive to the consequences of confessing to others, and I’ve had a few very uncomfortable conversations that ended in people losing my number or superiors telling me they didn’t need to know. When it comes to the former, it’s their choice, and it might be a wise one, but having those who stay close to me know my truths keeps me safe by making me accountable and protects others from being hurt. And I can hurt with the best of them. Maybe that’s why when it comes to physician treated addicted physicians, there are no secrets, no anonymity, the family and employers are made part of the process. Some notable addiction providers (like Journey Healing Centers and others) have programs that explicitly involve the family in the treatment process as well. Getting the secrets out works to break away from the shame.

We’re only as sick as our secrets, even together

On an organizational level, I understand the need for anonymity to avoid having any specific member represent the group. But that logic only holds when everyone is told to remain anonymous. Otherwise, the entire group represents itself, which is, if nothing else, truthful. If one person slips, relapses, or goes into a homicidal rampage, it only makes the rest of us look bad if no one knows that millions others are “the rest of us.”

Over and over I hear people talk about the secret of their addiction and the lies they have to tell to cover up their shameful acts. Unfortunately, that only contributes to the stigma of addicts and makes it all the more difficult  to get some perspective on the actual problem: We do things we don’t want to over and over regardless of how much they hurt us or those around us

If you’ve read anything on this site, you know that I believe in many factors that contribute to addiction, including biology, environment, experience, and their interactions. Still, when it comes down to it, the misunderstanding of addiction is often our number one problem. And anonymity does nothing to reduce that misunderstanding.

How we can make a difference

Media portrayals only exacerbate the problem as they show us stories of addicted celebrities who are struggling but then leave the story behind before any recovery occurs. That way we only get to see the carnage but have to look pretty hard to see anything more.

But we can change all this with a small, courageous, action. We can let those around us know that we’re addicts, that we’re doing our best to stop our compulsive behavior and that we want them to hold us accountable. If we slip, we can get back up because we don’t compound the shame of a relapse with lies we tell, and those around us know that even a relapse can be overcome because they’ve seen those examples over and over in all the other “confessed” addicts around.

It’s time to leave the addiction “closet” and start living. We may not be able to change who we are easily, but we can change the way we go about living and make it easier on ourselves and on others. By breaking our anonymity, we can help assuage our own shame and let everyone know that addiction is everywhere and that it can be successfully overcome.

Just a thought…