About Addiction: food, treatment, babies and teens

Our weekly About Addiction summaries are back! Make sure to tune in for the latest in research and news coverage of the drug abuse and drug addiction landscape. This time we’re talking about the food and drug addiction connection, drug using baby boomers, accidents, addicted babies, and drug using teens during summer breaks. If you

Food or drugs? A new study suggests a path for choice – A recent study Yale School of Medicine professors has found that neurons associated with overeating are also linked to non-food associated behaviors such as drug addiction. However, their discovery points to a relationship different than the contemporary view; they found an inverse relationship between eating and drug addiction that shows people who lack a desire for food have a higher predisposition towards drug addiction. According to their findings, it seems that the drive for food and the drive for drugs compete with one another!

Obamacare’s effect on addiction treatment – The recent ruling by the Supreme Court to uphold the Affordable Care Act was a huge moment in our country for many reasons. In the world of addiction, it has a great impact as well! By making sure all citizens have health insurance, it gives those seeking treatment a huge advantage: choice. In the past, those seeking addiction treatment could be limited by their insurance situation. Now, those seeking help will be able to get the treatment that is right for them, not just what is available to them. Also, substance abuse treatment will be able to have a more wide-reaching effect as treatment can be provided earlier as well as a preventative measure.

The dangers of driving high – According to a recent study done at Dalhousie University, marijuana use has a severe adverse effect on safe driving. This may not be new information, however this paper was the first to separate driving under the influence of marijuana from the influence of other drugs and alcohol. They looked at nine smaller studies including 49,411 people in order to calculate their results: finding that cannabis use nearly doubles the likelihood of a motor collision as compared to an uninhibited driver. With marijuana being the most widely used illicit substance in the world, with its usage rate still rising, it is important to separate the truths and myths about its effects.

Babies born addicted – This Thursday’s episode of Rock Center With Brian Williams featured a story on babies born with withdrawal symptoms from prescription painkillers. This is an epidemic in America, and the symptoms are heartbreaking to watch: the babies have tremors, digestive problems and cry inconsolably. There’s little doctors and nurses can do to comfort them as they slowly wean them off of the drugs. On this Thursday’s new Rock Center, Kate Snow reports on the shocking increase in the number of babies born addicted.

A Teenagers’ Summer: No school, less supervision, more drugs? – A new study released by SAMHSA (Substance Abuse and Mental Health Services Administration) reports that 671,000 teens aged twelve to seventeen will try alcohol for the first time this June and July alone; 305,000 teens will try cigarettes for the first time during these months, while 274,500 will have their first experience with marijuana. These numbers are an increase from the rest of the year, likely due to an increase in free time and decrease in adult supervision. While a large proportion of these individuals will never end up developing an addiction or substance abuse problems, this study makes it clear that the summertime may be a good time to talk to your kids about the risks and effects of these substances.

Spankings leading to drug abuse? New research reveals it may not be as far-fetched as you may think – The American Academy of Pediatrics (AAP) has released research that reveals strong links between corporal punishment in childhood and mood disorders, personality disorders, and addiction and drug abuse later in life. Specifically, according to the study, spankings raise the risk of alcohol and drug abuse by 59 percent. With a reported 94 percent of three- and four-year-olds receiving a spanking at least once in the last year, this has a widespread effect on the entire population. While one spanking does not lead to abuse, the research points to physical punishment as a regular means of discipline having adverse effects on mental health later in life.

Is grandpa getting high? More and more often the answer is becoming yes! – Drug use and drug abuse are often thought of in connection with young people, however the Baby Boomers are proving it can affect older people just the same. Last year alone an estimated 4.8 million adults aged 50 and above used an illicit drug. The risk is not just with illegal drugs, but also the misuse of prescription drugs. With the average 50-year-old-man using four different prescription drugs per day, the risk of becoming addicted to any one of them is substantial.

Seeing addiction as a disease, not a moral failing – In an interview with MSNBC’s Andrea Mitchell, director of the National Institute of Drug Abuse Nora Volkow explains how addiction and drug use affect the brain and why it should be considered a disease, not a moral failing. Check out this link to see the whole interview.

A3 Academy Intro Workshop – Level 1&2

Here at All About Addiction (A3), we take the issue of compulsive behaviors – addiction, anxiety, eating, sex, gambling, working, and more – very seriously. We believe that they are all related to one another and we’ve developed a treatment system that aims to quickly introduce clients to a number of tools that can help them make a difference in their lives quickly.

We’re going to hold an introductory workshop, one that addresses the issues, introduces everyone to the A3 Academy system, and takes you through levels 1-2 (of our 10-level system) all in a five hour workshop. See here for tickets – A3 Academy Tickets – for now, only those of you in Los Angeles will be able to attend, but in the future, to make sure we can help addicts everywhere, we’ll bring live streams back.

We’re going to keep the groups small, no more than 10 people per session, and there’s no long term commitment unlike with other treatment options. Anyone can attend this workshop – people struggling with compulsive behavior or addiction themselves, family members of loved ones who are struggling, or even those of you who are just interested and want to hear more.

We won’t make you label yourself (addict, ex-addict, whatever) and we won’t be asking you to commit to anything more than those 5 precious Saturday hours. We’re so sure that people will enjoy the workshop that we’ll offer you a money back guarantee – attend and feel like you got nothing? We’ll refund your money, no questions asked.

We’re looking forward to seeing you and helping you become the best you possible.

How to Give Up Giving Up – The Lexicon of success

When I was facing eighteen years in prison for a string of felonies long enough to make an organized crime boss proud, I made a decision that would alter the course of my life forever: I was going to change.

It’s not that I had a problem making decisions for myself before that time. I had begun my drug dealing career so I could get, and do, what I wanted: play music, party with beautiful women, get high, and have enough money to get my parents off my back. It worked, too. For a 23-year-old, I was hugely successful–as long as you only measure success by glitter and gold. I had the Teflon invincibility of a rock star, and the ego to go with it.  Until the day the cops busted down my door and took me to jail.

It wasn’t automatic, but after speaking with my attorney and weighing our options, it was clear that I needed to go to rehab. Not only had I been addicted to crystal meth for over three years, but my attorney was sure that if I didn’t base my defense on my drug addiction, I’d be braiding someone’s hair in prison well into my thirties.

People think drug addicts are weak,  but maintaining an addiction is hard!  Addicts have powerful wills and incredible problem-solving skills: drop an addict in the middle of lonely road in Montana and that addict will find his drugs faster than you can find your car keys.  I just needed to channel my abilities into something that wouldn’t kill me or confine me to a life behind bars.

So I did the thing that seemed to be in my best interest, not because I admitted failure or powerlessness, but because I decided to exercise my power in a new way.  Yes, I had to change course dramatically and leave the world I had built behind, but I knew that I wasn’t about to give up on life.

It was made obvious to me, as it eventually is to most addicts, that the path I was on was no longer going to take me where I wanted. So I changed direction. Now, don’t get me wrong: powerlessness came into play quite a few times during the process of shifting course, most notably when I got kicked out of my first rehab for using. But powerlessness is not a new concept and it is not at all unique to addicts–we are all powerless over some events in life; we have all confronted moments of profound hopelessness and despair.  All we can do, no matter the situation, is make the best choice we see at the time and go with it. We won’t always get it right.  We will make mistakes.

The question, however, is how we deal with outcomes that don’t suit us–how we respond to the inevitable “failures” that are the near-universal stepping stones to success. Life is less about never making a mistake or never walking down a wrong path; it’s about what you do when those things happen. Because they will, and they have–in every success story there ever was.

We’ve all heard these stories–Abraham Lincoln continued to run for office after losing five political races in a row.  Thomas Edison conducted over 6000 experiments in two years before he developed a reliable light bulb.  J.K Rowling was rejected by twelve different publishers before finally finding a home for the Harry Potter books and a level of success beyond her wildest imaginings.

As Edison put it: “If I find 10,000 ways something won’t work, I haven’t failed. I am not discouraged, because every wrong attempt discarded is another step forward.”

This simple mindset makes all the difference.  For those who will succeed, failure is not an option; it’s not part of their vocabulary.

So how can we mere mortals adopt this sort of thinking, this lexicon of success? How can we develop an unfailing belief in our ability and allow that belief to drive us forward no matter what?  Simply put, we must change our definition of failure and, in doing so, change our relationship with our struggles, our world, and ourselves.

You see, psychologists have long known that the best functioning individuals–those who seem happy and well-adjusted–don’t actually view the world realistically. They consistently overestimate their chances of success and their own performance. You might be thinking to yourself, “Shouldn’t I be striving for as objective a view of reality as I can muster?” Apparently not–not if you want a formula for success.  It may be counter-intuitive, but if the old ways haven’t worked, we don’t have much to lose in trying something different.

It’s hard to imagine a realist continuing his work after 100, 200, 500 failed attempts at creating an electric light bulb. Now imagine Edison’s 6000 such attempts and see: anyone objective would have quit, realizing that the likelihood of success seemed low. What about being defeated in five consecutive races for elected office? Would a realist muster up the courage to do all that work again, knowing the odds of failure? Imagine what our world would look like if Abraham Lincoln had believed in his defeats more than his vision and himself–we may never have seen Barack Obama take his oath.  Forget the “facts”–nobody has ever changed himself or the world by believing that what he’s seen before is as good as it’s going to get.

Successful people know there’s a chance of success, however distant or small, and they know they won’t quit until that success is in their hands.  Period.  So if true failure is really just giving up trying, there’s no way to fail if you simply keep going.  Seems like a winning recipe to me.

After I got out of jail and completed rehab, people often told me how amazed they were at my transformation.  I always told them, “I didn’t have a choice.”  But even though I believed it at the time, it wasn’t true – I had many specific behaviors to choose from: keep dealing, keep using, move, stay, get a job, go to school, and more.  And beneath those options, there was another, truly essential choice to make: to give up or not.  Not giving up meant a lot of work, a lot of struggle, and many possible “failures”.  But the alternative was simply not an option.

My first choice was to get a job, but after being rejected for a number of them, including one at a mall Apple store, due to my criminal record, I decided to go back to school.  It’s not that a Masters degree seemed more likely than a job at the mall; it’s just that I wasn’t going to take no for an answer.  I was not going to let my past mistakes determine what was possible for my future.  As we’ve seen, success doesn’t work that way.

Eleven years later, I’m sitting here writing this piece for Psychology Today, holding a Ph.D. in my hand (not literally, that would be weird), and helping others overcome. So screw Apple, screw the mall–screw all the messages we hear and the messages we give ourselves about what we can and cannot do.

Whether your struggle is depression, addiction, a personality disorder, or a difficult marriage, just remember that part of the equation of powerlessness has to do with the way you see the world. With the idea of failure removed, each setback is only a wrong turn, a corrective lesson for a fresh attempt–and not a sign of falling skies. So let yourself feel sad or disappointed if you hit a rough patch on your way, but don’t believe for a second you’re hopeless. Don’t let failure be part of your vocabulary. If we could predict success by track record, we’d all still be reading by candlelight.

The best addiction treatment option

I get asked which addiction treatment option is the best all the time. The short answer? Whichever one ends up working for the client.

I don’t like being stuck in the corner, having to pick a “best of” option just because I’m asked. For some clients Moderation Management will work, others need intense day-treatment or an in-hospital residential treatment program before moving into a more traditional residential place for a year or more. Some clients feel suffocated by such a structured environment and can’t manage it – outpatient treatment options can be a better fit there.

Sometimes we ask ourselves questions in a way that forces us to make bad choices: Which is better, chocolate or vanilla ice-cream? I reject the premise.

It’s about time we all faced the fact that only rare occasions allow for two-word answers that are absolutely true. The world is full of nuance and if we don’t start allowing some gray into our conceptualization of questions and answers we are going to keep repeating the past mistakes of polarized opposition to a small number of camps that are all equally wrong.

Brain research supports the notion that they way in which questions are posed can affect the sort of answers we look for – our brain pays attention to the stimuli it expects to find. So if you think that all you have to pick from are two or three options, your brain will calculate costs and benefits and spit out an answer – 42. It’s what happens when you ask the wrong question – you get a nonsensical answer.

So I don’t answer question like “which treatment is best?” or “which is more important, biology, the environment, or personality?” The way I see it the pieces are all so interconnected that the separation is false. The question is moot. And that’s true whether you’re picking addiction treatment or a your favorite cone.

Keep your head up – no shame in addiction

A client come in today for an addiction treatment evaluation. She had so much shame about her drug use that even the relative who brought her in didn’t know what drug she’d been using every day for the last year or so. I told her the same thing I tell all those who ask me for help – it is absolutely up to you to figure out who you feel comfortable telling about your alcohol, drug, gambling, or sex addiction problems. Just keep in mind that being shameful and secretive about your problems can cause addicts in recovery to be secretive when they experience cravings, triggers, and thoughts about using or acting out.

As hard as it is, disclosing these issues can provide an amazing amount of support while also allowing those close to you to be a real part of your recovery. Importantly, you don’t have to disclose to your significant other, your daughter, or your aunt. You can find an outside support system, either through peer-support groups like the 12-steps or SMART recovery or another group where you feel truly comfortable sharing. Shame will keep you isolated, sharing will help set you free.

Honesty, trust, and humility, along with the ability to admit that you are not necessarily managing recovery perfectly can actually be seen as strengths, not weaknesses. Try it out.

Criminal drug possession – Felony versus misdemeanor

In all but 13 States in the U.S., drug possession for personal use is still considered a felony punishable by years in prison and hefty fines. This despite the fact that a significant portion of those arrested meet criteria for dependence (addiction) on the drugs they are caught with, and the fact that our own federal drug abuse agencies (The National Institute on Drug Abuse – NIDA) considers addiction to be a medical condition that involves reduced control over the drug use itself. I guess that’s why the federal government also considers possession for personal use as a misdemeanor.

Drug users don't belong in prisonIn essence these state laws are putting drug users, and especially drug addicts, at risk of being locked up for years, placed on parole, and subject to the endless other barriers to employment and housing, which make it more difficult for these convicted felons to reintegrate into the community. As if fighting drug addiction wasn’t hard enough.

The question is, would reducing the penalty for drug possession for personal use to a misdemeanor in more states result in increased drug use and crime or would it actually help free up resources being used for incarceration towards more effective strategies for combating the problem?

California State senator Mark Leno is bringing up a bill for consideration in the state senate (SB1506) that is seeking to do just that – reducing the penalty for possession for personal use of any drug to a misdemeanor. Mind you, this law is not to affect any other drug-related offenses such as drug possession for sale, drug manufacturing, or transportation. What it would do is cap the maximum incarceration length of possession at one year in jail (not more years in prison) as well as cap the maximum community supervision length at 5 years (3 years are commonly assigned for such offenses).

I know what some of you are saying – drug users know they’re breaking the law and they should be punished for it. Indeed, punishing them for it will make them less likely to use, which will leave them facing no jail time instead of continuously facing single years in jail for reduced drug possession offenses. Besides, if we cut the penalties for drug possession aren’t we being soft on crime? Aren’t we saying that using drugs is okay?

The problem with that argument is that it assumes that states that have higher penalties for drug possession for personal use have lower rates of crime, drug use, or drug possession arrests. The don’t. Indeed, the 13 states (and D.C.) that already consider drug possession for personal use a misdemeanor have incarceration rates that are no higher, illicit drug use rates that are slightly lower, and addiction treatment admission rates that are on par and even a bit higher than the rates of felony states. Again, that means the states that reduced the penalty for drug possession see less arrests, more people in addiction treatment, and a smaller percentage of their population using such drugs. Interestingly, those results are somewhat similar to the effect complete decriminalization had on drug use, crime, and addiction treatment in Portugal.

In previous articles we’ve spoken about the stigma of addiction and the barriers people report to entering addiction treatment in the U.S. Aside from cost and lack of information, people usually report that they either don’t want help, think they can handle the problem on their own or are too ashamed to ask for help. We’ve also reported on the ridiculous prison overcrowding problem in California due to the high incarceration rates of drug users. The question of decriminalization has come up many times (see here, here, and here) and the evidence I’ve seen keeps pointing towards the conclusion that reduced penalties get more people into addiction treatment while reducing incarceration rates with no real collateral increased in illicit drug use or crime. When you think about it, since the Harrison Narcotics act of 1914 essentially created the black drug market in the U.S. when it restricted, for the first time, the sale of narcotics, it makes sense that loosening up those restriction would reduce the size of that same black market and with it drug-associated crime.

I have spent the last 10 years researching the best ways to fight addiction problems and almost everything I’ve seen suggests that treatment and prevention efforts, not long jail or prison sentences, are the best ways to combat the problem. I have seen evidence that very shirt-term incarceration can help certain resistant offenders, but those efforts can easily be applied for misdemeanor and require nothing close to multiple-year sentences. For that reason, I support not only Senator Leno’s SB1506 bill in California, but other efforts around the country to reduce the criminal penalties associated with simple drug possession to get more of the people who need help into addiction treatment and away from jails. It saves us money, it is more humane, and it just makes sense.

If you want to help Senator Leno pass this bill, contact his office through this link: http://sd03.senate.ca.gov/

 

Citations/Reading:

U.S. Census Bureau, 2012 Statistical Abstract, Table 308. Crime Rates by State, 2008 and 2009, and by Type, 2009 (2012).

Collins et al., (2010). The Cost of Substance Abuse: The Use of Administrative Data to Investigate Treatment Benefits in a Rural Mountain State. Western Criminology Review 11(3), 13-28.

Gardiner, Urada, and Anglin (2011). Band-Aids and Bullhorns: Why California’s Drug Policy Is Failing and What We Can Do to Fix It. Criminal Justice Policy Review, 23, 108-135.

Barriers to Addiction Treatment Entry

By Dr. Adi Jaffe and Tariq Shaheed

How annoying is it to be running late for work unable to find your keys, wallet, or coveted smart phone? You check under the bed, between the sofa cushions, and in your useful phone valet, before giving up and calling in late to work (if it’s not your phone you’re missing). You ask your wife, who says she hasn’t seen it, and your child, who thinks it’s under the bed (you’ve looked, it’s not). Finally, giving up, you go to your car, where your phone sits smugly right on the passenger seat. As troubling and frequent as this story might be, it’s nothing compared to the difficult experience of over 20 million Americans who annually look for addiction treatment but don’t find it [2]. So what’s keeping so many Americans out of treatment?

Internal and external barriers to addiction treatment entry

Barriers to addiction treatment entry are plentyIn a study done in 2008, researchers surveyed a sample of 518 subjects varying in race and age, to find out about the barriers keeping them out of addiction treatment. [1] The study was conducted in Montgomery County Ohio, was a part of nationally funded “Drug Barrier Reduction” effort lead by the National Institute on Drug Abuse (NIDA). Most participants were using crack (38.4%), heroin (25.1%), marijuana (14.9%), and alcohol (11.2%). The researchers found a number of internal and external barriers that keep drug abusers from getting the help they need. Internal barriers included stigma, depression, personal beliefs, and attitudes about treatment, while external barriers (systematic or environmental circumstances that are out of a person’s control) include time conflicts, addiction treatment accessibility, entry difficulty, and cost of addiction treatment. [1]

The researchers concluded that both internal and external barriers can be addressed and improved, but that eliminating the external barriers to addiction treatment is most feasible and could substantially decrease the number of untreated addicts in the United States. Since addressing an internal barrier like “believing one can quit at anytime” (accounts for 29.3% untreated Americans) still requires the ability of the substance user to get treatment, it seems that addressing external triggers will be more immediately effective. Just as motivation to find an item such as keys, phone, or wallet is not the only factor in obtaining that item, a substance user with no internal barriers to treatment is still constrained by all those external barriers, and still not in substance abuse treatment.

The most commonly cited external barriers in the study were:

  1. Time conflicts – being unable to get off work for treatment, household obligations, busy schedules and simply not having time for substance abuse treatment.
  2. Treatment accessibility –  living too far away for treatment, not knowing where to go for treatment, having difficulty getting to and from treatment, and not understanding the addiction treatment options. Subjects reported that being wait-listed for a facility, and having to go through to many steps contributed to deterring them from seeking treatment.
  3. Financial barriers included inability to pay for treatment and being uninsured.

Some common internal barriers include:

  1. Stigma associated with the label of being call an alcoholic or an addict, or stigma regarding addiction treatment. Thus being unwilling to share problems and ask for help.
  2. Psychological distress such as depression and neuroticism which produces a lack of motivation among substance abuse treatment seekers.
  3. Personal beliefs
    1. Religion- God will remove the addiction at the right time
    2. Denial – User doesn’t believe they are an addict
    3. Doesn’t need treatment – For example 30% of heroin abuser believed they would recover without treatment.

Although getting substance abusers help is difficult, it starts by understanding the nature of the problem. While one person may not believe they are addicted, another may not understand how sliding scale payment for treatment works. Different individuals may need different helpful resources when it comes to understanding their options.

Thoughts and limitations regarding the research

As we pointed out in a recent article, it’s important to know who is participating in addiction research. In this case, the individuals recruited were reporting for substance abuse treatment assessment at a county intake center. This means the clients are likely from relatively low Socioeconomic Status (SES) groups, but also that they are for some reason motivated to find treatment. Those reasons themselves could be internal (decided to make a change) or external (got arrested), but it’s important to know that these findings do not necessarily apply to more affluent, insurance carrying, or addiction treatment uninterested, individuals. We are currently in the process of conducting a more general study to assess needs in that group.

Also, the time and costs constraints identified by participants can often be overcome by increasing flexibility in searches and by better tailoring the treatment referrals (see our Rehab Finder articles). Costs can be reduced while saving time by looking into outpatient, rather than residential, treatment options. Unfortunately, Americans have been exposed only to the residential treatment model (a la the Dr. Drew and Intervention television shows), but outpatient addiction treatment is effective, costs less, and truly a better fit for many clients (especially those still working, attending school, etc.).

Finally, not all of the internal beliefs can be written off as unreasonable barriers – indeed, it is likely that most individuals who do not seek official substance abuse treatment, and certainly most of those who never enter official substance abuse treatment, will still recover from their addiction without it. As we pointed out in previous articles (see here, and here), most people who use drugs do recover and many do it with no treatment per se, especially when looking at our biggest substance abuse problem – alcohol. That means that some people termed “in denial” and “not needing treatment” were actually either correct, lucky, or both. Recovery doesn’t have to look like we expect it to, it just has to result in a person who is no longer suffering with addiction.

A3 Plug (you knew it was coming)

At A3 we believe information is the key; by dispelling myths about addiction, removing stigma and anonymity, reviewing the latest research in treatment, and finding 21st century solutions to barriers, we hope to reduce the number of untreated. Join us in the fight to educate and treat addiction.

Citations:

1. Jiangmin Xua; Richard C. Rappa; Jichuan Wanga; Robert G. Carlsona. (2008) The Multidimensional Structure of External Barriers to Substance Abuse Treatment and Its Invariance Across Gender, Ethnicity, and Age.
2. An investigation of stigma in individuals receiving treatment for substance abuse