Addiction stories: How I recovered from my addiction to crystal meth

By the time I was done with my addiction to crystal meth, I had racked up 4 arrests, 9 felonies, a $750,000 bail, a year in jail, and an eight year suspended sentence to go along with my 5 year probation period. Though I think education is important to keep getting the message out about addiction and drug abuse, there is no doubt that addiction stories do a great job of getting the message across, so here goes.

My crystal meth addiction story

The kid my parents knew was going nowhere, and fast. That’s why I was surprised when they came to my rescue after 3 years of barely speaking to them. My lawyer recommended that I check into a rehab facility immediately; treating my drug abuse problem was our only line of legal defense.

cocaine linesI had long known that I had an addiction problem when I first checked myself into rehab. Still, my reason for going in was my legal trouble. Within 3 months, I was using crystal meth again, but the difference was that this time, I felt bad about it. I had changed in those first three months. The daily discussions in the addiction treatment facility, my growing relationship with my parents, and a few sober months (more sobriety than I had in years) were doing their job. I relapsed as soon as I went back to work in my studio, which was a big trigger for me, but using wasn’t any fun this time.

I ended up being kicked out of that facility for providing a meth-positive urine test. My parents were irate. I felt ashamed though I began using daily immediately. My real lesson came when I dragged myself from my friend’s couch to an AA meeting one night. I walked by a homeless man who was clearly high when the realization hit me:

I was one step away from becoming like this man.

You see, when I was in the throes of my crystal meth addiction, I had money because I was selling drugs. I had a great car, a motorcycle, an apartment and my own recording studio. After my arrest though, all of that had been taken away. I just made matters worse by getting myself thrown out of what was serving as my home, leaving myself to sleep on a friend’s couch for the foreseeable future.

Something had to change.

homelessI woke up the next morning, smoked some meth, and drove straight to an outpatient drug program offered by my health insurance. I missed the check-in time for that day, but I was told to come back the next morning, which I did. I talked to a counselor, explained my situation, and was given a list of sober-living homes to check out.

As I did this, I kept going to the program’s outpatient meetings, high on crystal meth, but ready to make a change. I was going to do anything I could so as not to end up homeless, or a lifetime prisoner. I had no idea how to stop doing the one thing that had been constant in my life since the age of 15, but I was determined to find out.

When I showed up at the sober-living facility that was to be the place where I got sober, I was so high I couldn’t face the intake staff. I wore sunglasses indoors at 6 PM. My bags were searched, I was shown to my room, and the rest of my life began.

I wasn’t happy to be sober, but I was happier doing what these people told me than I was fighting the cops, the legal system, and the drugs. I had quite a few missteps, but I took my punishments without a word, knowing they were nothing compared to the suffering I’d experience if I left that place.

Overall, I have one message to those struggling with getting clean:

If you want to get past the hump of knowing you have a problem but not knowing what to do about it, the choice has to be made clear. This can’t be a game of subtle changes. No one wants to stop using if the alternative doesn’t seem a whole lot better. For most of us, that means hitting a bottom so low that I can’t be ignored. You get to make the choice of what the bottom will be for you.

You don’t have to almost die, but you might; losing a job could be enough, but if you miss that sign, the next could be the streets; losing your spouse will sometimes do it, but if not, losing your shared custody will hurt even more.

At each one of these steps, you get to make a choice – Do I want things to get worse or not?

Ask yourself that question while looking at the price you’ve paid up to now. If you’re willing to go even lower for that next hit, I say go for it. If you think you want to stop but can’t seem to really grasp just how far you’ve gone, get a friend you trust, a non-using friend, and have them tell you how they see the path your life has taken.

It’s going to take a fight to get out, but if I beat my addiction, you can beat yours.

By now, I’ve received my Ph.D. from UCLA, one of the top universities in the world. I study addiction research, and publish this addiction blog along with a Psychology Today column and a number of academic journals. I also have my mind set on changing the way our society deals with drug abuse and addiction. Given everything I’ve accomplished by now, the choice should have seemed clear before my arrest – but it wasn’t. I hope that by sharing addiction stories, including mine, we can start that process.

Compulsive choices in addiction?

Is addiction an issue of bad choices or is it a case of biological, compulsive, necessity?

If you know anything about me and my views, you know that I think little of anyone who tries to separate these. I see and talk to people all the time who are stuck in compulsive behavioral patterns but with some education and good helping of supportive tools they can begin to change these patterns and return to normal life.

But then there are those who just don’t seem to ever get better.

The frustration and shame that come along with compulsive, addictive, behavior can be greatBe it lack of motivation, readiness, mental health issues, or a simple case of not having found a good enough reason to stop, these addiction clients can be the most frustrating and the most rewarding to work with. Any victory, no matter how small, with a difficult patient can put a big smile on my face. I love nothing more than to have someone tell me that they’re sending me a very “tough” or “resistant” client only to discover that when they’re with me, neither of these traits is really representative of their personality.

Or maybe it’s just a matter of perception, right?

Life is about choices, and compulsive or addictive behavior is certainly included in that equation. But that doesn’t mean that all choices were created equal. Indeed, all the evidence points towards the conclusion that choices are differently easy or difficult depending on a person’s experience, biology, and environment. In so many animal studies (called conditioned place preference experiments) researchers have shown that exposure to an environment in which drugs are given makes an animal much more likely to spend time there. We’re talking about 3 to 4 exposures at most and animals find it hard to leave – imagine what 3 to 4 years of that kind of exposure can. Self-administration studies (the kind where animals press levers and buttons for drugs) have revealed that animals can go through some pretty lengthy, complicated procedures to get their drugs and that their experience makes them continue pressing for a long time after the drugs have been removed from the equation. If a rat can learn to press one button, wait some time before pressing another, and finally poke his nose in a whole to get a hit, you can bet that people can do the same without needing to resort to explanations about unhealthy family environments. Family environments matter, as do friends, neighborhoods, and cultures – along with neuroscience they all create the picture we end up calling addiction.

As far as I’m concerned, there is no doubt that experience with drugs can lead to reduced self-control over activity that has been linked with drugs. Add triggers and cravings to the mix and the question of some compulsivity in addiction seems moot to me. Still, there is no doubt that compulsive or impulsive behavior can be helped when you’re not approaching the client as if they are somehow flawed but that doesn’t mean they weren’t compulsive in the first place.

Trying to make the picture simpler is like trying to draw a Picasso without being able to sketch a simple bowl of fruit – it might fool those who don’t know much but it’s far from true cubism.

The Myth Of “Loss of Control” As A Scientific Truth Of Addiction

All About Addiction aims to be a place where an open conversation about issues relevant to addiction can be discussed. To that end, the following is a piece from Christopher Russell that challenges the notion that people in some way lose control over their behavior suggesting instead that their seemingly compulsive behavior is actually volitional. Look for an upcoming post featuring Dr. Jaffe’s views on some of the points made by Christopher.

The Myth of “Loss of Control” – By Christopher Russell

Popular wisdom among addiction neuroscientists states that while initial drug use is voluntary, with repeated drug consumption the consumer moves closer to a critical, tipping point separating non-addicted from addicted drug use (e.g. Leshner, 1997). At the passing of this critical point, believed to reside in drug-induced changes to one or more brain sites and gene expression, the individual is argued to lose his ability to control his use of drugs thereafter. Beyond this point, drug use is now something which happens to the individual, compelled by pharmacological causes, not something the individual does for phenomenological reasons.

This notion of a physical “loss of control” as an explanation for why some people continue to use drugs has prevailed as the core hypothesis of the view of addiction as a progressive disease for the past 200 years (Levine, 1978) and today remains largely accepted by the general public as a taken-for-granted, scientifically-proven truth of addiction. Furthermore, the primary use of the word addiction has come to describe a particular set of behaviours which have a causal basis operating irrespective of the will of the individual (Davies, 1996), with “addicts” used as the term to distinguish those who are no longer able to control their drug use from those who are still able to control their drug use.

But why has this belief become so ubiquitous among the general public when the neuroscience community has produced no evidence which is sufficient to warrant the conclusion that certain individuals are physically unable to stop using their drug? Additionally, no evidence has been provided which warrants the conclusion that a critical, tipping point exists in the brain at which a person shifts from non-addicted to addicted drug use, the point at which the “loss of control” is assumed to occur. Both beliefs remain hypotheses for which there is as yet no evidence, however, the public  understanding tends to be that these arguments have been long since proven as basic truths of addiction. What we do know and can show today is that some people find quitting a drug to be easy, a bit hard, quite hard, or extremely difficult. But evidence of the difficulty to exercise control should not be confused with an inability to exercise control, no matter how much the evaluation “I can’t stop” feels like a literal truth about our capabilities. This 3-part blog describes what we can and cannot show about the nature of drug use today and why the “loss of control” myth has prevailed as a “fact” of addiction for many people.

What we can and cannot show about addiction today

What we can and cannot show about the nature of addiction today is summed up by Akers (1991), a sociologist:

“The problem is that there is no independent way to confirm that the “addict” cannot help himself and therefore the label is often used as a tautological explanation of the addiction. The habit is called an addiction because it is not under control but there is no way to distinguish a habit that is uncontrollable from one which is simply not controlled”.

In other words, we have only shown that some people do not stop using drugs, not that they cannot stop using drugs. The belief that some people cannot control their drug use will soon be shown to be a scientific fact, which comes from the moral judgment that people who do not stop when they say they really want to stop and who continue to use even to the detriment of other important things in life like work and relationships must be doing so not of their own will, but rather, their behaviour must be being compelled by a force outside of their will. In other words, the value-laden judgment is that no person in their right mind would voluntarily pursue this life; therefore, it fits with our view of a moral society to think that a drug “addict” is not a morally reprehensible person, but rather, must be using drugs against his will. But we must remember that to say “for why else would this poor person continue to use drugs?” is a value-laden statement about how we believe morally decent humans should behave. We should not infer that people cannot stop using drugs simply because we observe them not stopping. This may be useful information in itself, but is not evidence of a loss of control.

What medications do and do not do

Of course I do not deny that the use of medications like naltrexone, acamprosate and buprenorphine make it easier to forego certain drug use by blocking parts of the brain which motivate drug use. I would encourage people to use these medications if they find it helps them to not use other drugs. However, reducing the difficulty of quitting should not be confused with restoring the individual’s ability to quit as if this ability was at any point lost. Medications can help people quit using drugs and great strides are being made to manufacture medications which make the process of quitting easier to do and tolerate. However, these medications are not necessary for controlling drug use in the way heart medicines, radiation therapy, and insulin is necessary to stave off the mortal threats of heart conditions, cancers, and diabetes respectively.  These groups of people do not have agency over their conditions in the way drug users have over their behaviour.

No medication has yet been shown to restore a drug user’s free will to reject drugs. Additionally, manufacturing medications has long been considered by addiction researchers such as Bruce Alexander, Stanton Peele, and John Davies to be focusing on the thin edge of the wedge; too much focus on the uses of medication, they would argue, restricts the need for drug users and treatment providers to consider a broad social analysis of why drug use is so prevalent in our societies.

The paradox of “behaving responsibly” after control is lost

The paradox inherent to the belief that some drugs erode free will and others can restore free will is that a drug user is expected to exercise his control and his will to sign up for and attend treatment and take medication like a “responsible” person should do precisely when we believe he has been robbed of his control and will to make choices about drugs. This paradox is also seen in the myth that an “addict can only quit after he hits rock bottom” which is promulgated by the 12-step movement; we expect people to show free will to quit precisely when they are thought to be least free to make choices about drugs. In other words, we expect so much self-control from those we believe are no longer capable of self-control!

The defence of this paradox has tended to be along the line of “he has not lost his free will to control all parts of his life, only the parts which involve drugs”. In one of his early speeches in San Diego, June 6th, 1989, William Bennett, former National Drug Policy Director and drugs czar appointed by President George H. W. Bush, defined an “addict as a man or a woman whose power to exercise rational volition has been seriously eroded by drugs, and whose life is organised largely – even exclusively – around the pursuit and satisfaction of his addiction”. Bennett’s statement reflects a common logical contradiction. Organisation of one’s life around anything is a rational skill, a wilful act, often requiring complex cognitive operations to be performed such as planning for an event which is two and three moves ahead. As Schaler (1991: 237) notes, “If an addict’s power to exercise rational volition is seriously eroded, on what basis does the addict organise life?” Interestingly another curious medical-moral contradiction by Bennett was noted by Massing in his book The Fix. Massing said “Addicts were in his (Bennett’s) view irresponsible individuals lacking basic levels of self-control” (p195). If these people do lack the capacity for self-control, how can they be responsible for not showing self-control? If they were irresponsible, it is their irresponsibility which causes drug taking; self-control is irrelevant. Bennett appears to be of the view that addiction is a moral failing which the addict is helpless to prevent, which is logically impossible.

Instead, what we do observe is that drug users are actually very good at putting in place the conditions by which drugs can be obtained, and that many people who are diagnosed as drug addicts do show a great capacity for self-control of behaviours except for those involving drugs. So addiction neuroscience is not pursuing a neurobiological basis of free will, per se, just the basis of our free will to control drug use, which is an even harder premise to swallow.

Stay tuned for Dr Jaffe’s reponse and part 2 coming soon.

References:

Akers, R. L. (1991). Addiction; the troublesome concept. The Journal of Drug Issues, 21(4). 777-793. (only available in print form at present).

Davies, J. B. (1996). Reasons and causes: Understanding substance users’ explanations for their behaviour. Human Psychopharmacology, 11, 39-48.

Leshner, A. I. (1997). Addiction is a brain disease, and it matters. Science, 278,45−47.

Levine, H. (1978). The discovery of addiction: Changing conceptions of habitual drunkenness in America. Journal of Studies on Alcohol, 39, 143−174.

Massing, M. (1998). The Fix. University of California Press Ltd; London England.

Schaler, J. A. (1991). Drugs and free will. Society, 28(6), 235-248.

Biology versus Choice: Is a simple explanation of addiction enough?

At the recent Addictions conference, held in D.C. and sponsored by Elsevier, a well known academic publishing house, I got myself into one of those long debates with a fellow addiction researcher. The question we were debating was whether addiction is primarily biological or if it is mostly a matter of personal choice. We ran through research evidence, the notion of stigma, and more, making us late for the afternoon session of talks – but it was worth it.

My take on it was that one can’t separate biology from choice, a point I have made over and over (see my choice Vs. control talk), and that ignoring the biology of addiction is therefore impossible. My opponent across the stage (or lunch table as it were) was Christopher Russell, a graduate student at the University of Strathclyde in the United Kingdom who is a bigger believer in the choice view of addiction, along with people like Dr. Bruce Alexander of Rat Park fame and Dr. Gene Heyman who wrote “Addiction is a disorder of choice.”

I like good debates and at as far as I understand it Christopher and I ended-up agreeing that as usual neither biology, nor choice, do a good enough job of explaining a complex disorder like substance abuse and addiction. I’ve been making that point for a while, so I’m pretty comfortable with the final conclusion – Biology, environment, and choice (cravings) all factor into addiction as I understand it. Without understanding the machinery and how genetics and behavior affect it, I think the rest of the discussion is moot, but it is pretty much as pointless without addressing environmental influences and the role of choice.

I liked debating with Christopher so much that we’re going to be bringing him on a writer on A3. He’ll help us keep on top of the most recent addiction research and news while bringing in another voice on the topic that I think will help move our discussion forward. So please help me welcome Christoper Russell from the U.K., and look ahead for his contribution as well as a likely ongoing debate about the importance of biology versus personal choice.

Choice and control in addiction – Genetics and neuroscience of drug abuse

Dr. Jaffe recently gave an online lecture (webinar) for HealthCentral on the processes involved in choice and control of behavior during addiction and drug abuse. We’ve written quite a bit on here about the neuroscience of impulsivity issues and the genetic predisposition to addiction and this talk really covers some of the most important aspects of this topic. I’m also attaching a link to the presentation materials that go along with this talk so that you can follow along (Wellsphere Webinar 1 – Choice Vs. Control). There was definitely quite a bit of material (on both neuroscience and genetics) that we couldn’t get to, so hopefully having the presentation will help you follow along and learn.

We hope you enjoy!

Control Versus Choice in addiction


Watch live video from HealthCentral on Justin.tv

If you need help finding treatment for your own, or a loved one’s addiction, make sure to give our Rehab-Finder a try: It’s the only evidence-based, scientifically created, tool for finding rehab anywhere in the United States!

Addiction is a disorder of control, not choice – A response to Heyman’s book

I was working on the first chapter of my book today and the issue of choice plays a prominent part in it. I’m a little pissed at Dr. Heyman, whose name sounds like something a stoner might say, about his book, “Addiction – A disorder of choice”.

The thing is that at its most basic, every action we perform seems like a choice. Whenever you take a step, think a thought, or feel a feeling, you’re “choosing” that specific action rather than an almost endless number of other options.

However, when choices are involuntary, or are made below the level of consciousness, as is often the case not only with addiction but in many other instances in life, than I believe the word choice is being misused. Dr. Heyman knew that his book would cause controversy, but he also knows very well that the mere exposure to substances can cause profound changes in the way animals make choices.

Drugs alter the way the brain works, including the ways choice are made. They affect the internal value given to rewards, they alter the brain’s ability to adjust to new situations, and they change the brain’s basic neurochemistry to cause profound effects on overall function that no doubt alter many more processes.

And I haven’t even touched on the ways that different people are pre-programmed to make choice in different ways because of their genetic make-up. Whether you call it choice or not isn’t the question. Rather, the question is one of control. Addiction is a disorder of control.

Addiction causes – Genetic variability related to attention, impulsivity, and drug use.

It will probably come as no surprise to at least most of you that addiction is closely linked to problems of self-regulation (like ADD and ADHD). This is one of the main reasons that professionals view addiction as a disease, and not a choice.

This post is pretty advanced, but it should leave you knowing a lot more about the relationship between attention, self-regulation, impulsivity, and addiction. Also, when I use the term “Addiction causes” I have to stress that the link to date has been one of association, NOT causation. We don’t truly know what causes addiction.

What is self-regulation?

Self-regulation is the ability to control one’s actions in ways that are appropriate to specific situations. Having to do with the most advanced aspects of cognition, self-regulation is considered to be the prime example of human executive functioning. It’s this aspect of thought and brain function that is thought to truly separate humans from other animals.

Being this important for our functioning, you can probably imagine how complex and interactive the brain systems that control executive functioning are. You’d be right.

These systems, centered in the Prefrontal Cortex (PFC), the part of the brain nestled right behind your forehead, are connected to essentially every other brain system, including vision, hearing, motor control, emotion, etc. It’s the PFC that controls these systems and tells the brain what brain impulses should actually be acted on.

And impulses is a great word for it. Given how complex the system is, there are many things that can affect its function. There are genetic factors, some that have to do with early development, and others that are affected by behavior, including the ingestion of drugs.

In this post, I would like to focus on the genetic influences, later on, I’ll talk about the developmental influences and the effects of drugs and other behavior on these systems.

Genetic influences on executive function:

There are a host of genes that affect different aspects of executive function. Some of these, like those impacting genes related to DAT, DRD4, and COMT functioning, have an effect on dopamine function that has been correlated with personality traits like sensation seeking and impulsivity.

Hyperactivity

As I’d mentioned earlier, these personality traits themselves, and the genes that affect them, have been found to be associated with addiction as well as several other conditions and syndromes that are related (such as ADD and ADHD).

Just to be clear, we all have these genes, but there are different version of them (called alleles). Some of these versions are more common than others, and some are associated with the conditions I mentioned earlier.

For instance: There are 2 versions of the COMT gene. This gene codes for a chemical in the brain that breaks down DA (this breakdown is important for brain function as I’d mentioned in an earlier post). One of these versions (named MET) breaks dopamine more slowly while the other (VAL) breaks it down quickly. The VAL allele actually breaks the dopamine down so fast that it interferes with dopamine’s ability to properly get its message across. That’s why this allele has been linked to attention and impulsivity issues. Each of these alleles has a 50% prevalence in society, which means that 1 out of 2 people have the VAL allele. Obviously its effect is not enormous, but along with many other factors, it has a significant impact on dopamine functioning.

Similar issues come up with one of the versions of the DRD4 gene, which codes for a specific type of dopamine receptor; and with the DAT gene, which codes for the DAT transporter I talked about in the cocaine post mentioned earlier.

Again, while the effects of each of these genetic variants is small, these can add up along with other genetic influences and environmental factors (especially during early development) to overall affect a person’s ability to control impulses.

Obviously, those who have a more difficult time controlling their impulses would have a more difficult time making appropriate choices. These difficulties can lead some to be more likely to start behaviors that are detrimental, including the use of drugs. The drugs themselves can then further exacerbate the problem (as we’ll see in a future post), and can do other things to make users more likely to keep using them.

In short, while genes don’t make people use drugs, they can definitely make it more likely for certain people to engage in risky behavior, including trying drugs in the first place…

Question of the day:
Did any of the people you know who have developed drug use/abuse problem show problems with impulsivity before their drug use?