The music must change! Obsesssion, compulsion, shame an guilt in addiction

Guest co-author: Jeff Brandler from Changeispossible.org

The nature of addiction is one of obsession and compulsion. Regardless of the substance, behavior, or process, the addicted person will continue to obsess (countless and endless thoughts) and have compulsions (repetitive actions). They will repeat this obsession-compulsion ritual over and over.

music-sheetImagine a radio station that plays the same song over and over. Imagine that song being a steady diet of thoughts, and feelings of guilt, shame, remorse and self-loathing (GSRSL). Imagine an endless supply of obsessive thinking and compulsive replays of the thing(s) that the addict did to start the song playing.

People get involved in all kinds of self-defeating/self destructive behaviors. There are numerous reasons for this. The top ones that I see are: addictive disorders, mood disorders, self-sabotaging behavioral and personality traits. The GSRSL is a constant loop. It never stops. The problem with it never stopping is that it creates more GSRSL. The more GSRSL, the greater the need for the behavior. The more behavior that happens, the more GSRSL that you need and so on and so on. Does your head feel like it wants to explode?

Obsession and Compulsion – An example

Let’s say I had a fight with my spouse. I decide to smoke a joint in order to relax, escape, or unwind. Afterwards, I feel a lot of GSRSL. I have guilty thoughts, feel embarrassed and shameful. I have remorse for what I did, and beat myself up unmercifully. So what do I do in order to stop this behavior? You got it, smoke another joint, or maybe have a drink, only to feel more GSRSL. In doing so I then have the trifecta GSRSL of before, during and after-The music must definitely change!!!!

Or, imagine an alcoholic who receive a 3rd DWI citation after finally getting his license back following a 2 year suspension for his previous offenses. That’s some serious GSRSL. I have the most recent driving incident plus the 2 years where I lost my license swirling around my head like a blender. Talk about a bad song!!!! Please change the music!!!!

How does a person change this music?

It’s easy to change a radio station, but something that is so ingrained, so obsessive & compulsive is going to be much harder to change. Part of stopping this music is recognizing: 1) this is going to be hard to do 2) that I have been doing this for a while, and 3) it’s going to take some time to stop it. The key word that describes this is permission – I have to give myself permission to take the time that it’s going to take to make this major change. I’m also going to need to use a variety of approaches to change these thoughts and feelings (i.e. thought stopping, disputing irrational beliefs, identifying affirmations, (and using them regularly), and finding gratitude despite the pain).

Using this total package will be a first step towards change. It begins a long process of turning down the GSRSL music . I may need to also speak to a therapist to examine why I do these behaviors and what they are “wired” to. If in fact there is something biologically based, there may be a need for medication to “tune” these thoughts/feelings into healthier ones. Yes the music can change– It can go from “Comfortably Numb” to “Peaceful Easy Feeling”. The process of change is possible, but it’s going to take time and hard work.

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…

Obesity, drug addiction, and dopamine

Eating junk-food can be addictive, and apparently, it causes brain changes that look eerily similar to drug addiction. That’s the message not only from the rapidly fattening waistlines of Americans everywhere, but also from the Johnson and Kenny labs at the Scripps Institute.

Food and drug addiction

The idea that obesity is caused by a compulsive pattern of eating, and that there could be a similarity between such compulsive eating and drug addiction isn’t super new. In fact, Dr. Volkow from NIDA seemed to make research into this association her goal when taking  the helm of the addiction research kingdom.

When you think about it, the notion isn’t far-fetched: Drug addicts continue to take drugs, in increasing amounts, even though they’d often like to stop (at some point) and in the face of negative consequences and the common loss of other important life functions (like family, work, etc.). Obese individuals are quite the same, eating more and more food regardless of their desire to adopt a healthier diet and in-spite of ridicule, low self-esteem, and decreased functioning that often accompanies extreme weight gain.

The research by Johnson and Kenny examined whether exposure to the kind of high-fat, super high-calorie foods that floods the junk-food market are responsible for creating food-addicts in a similar way to drugs that alter the brain in ways that make stopping more difficult.

Dopamine, reward, and junk-food

The study took three groups of rats and gave them either the regular chow diet lab animals are used to or the worse kind of birthday party food: bacon, sausage, cheesecake, pound cake, frosting and chocolate. You can imagine the party going on in the rat cages that got to eat that! Of the two groups that got to eat the crazy-fat food, one had unlimited access while the other got to binge for only one hour a day.

The bottom line: Only the rats that got unlimited access to the fat-party food developed compulsive eating habits that resulted in roughly twice the weight gain of the other two groups and the ability to continue eating even in the face of signals for punishment (a light that they were trained to associate with shocks).

When the researchers looked deeper, they found that the brains of these rats suffered a significant reduction in the density of a specific kind of dopamine receptor (D2) in a brain part known as the striatum, the same kind of reduction common in drug addicted people and obese individuals. This receptor type is often thought to be important for regulation of impulses, both physical and otherwise. It therefore makes sense that losing this type of function would cause uncontrollable eating or drug taking.

Are drug- and food-addictions the same?

While this research isn’t saying that compulsive eating, or obesity, are the same as drug addiction, it does strongly suggest that there are common mechanisms in both. More importantly, it reveals a common process that unfolds when over-exposure to the reward, in this case food, occurs. This tells us that there can likely be common pathways to these different addictive disorders, though whether any specific person ended up a food- or drug-addict because of this kind of process is still an open question. I wonder if we’ll see something like this with sex addiction soon…

Citation:

Johnson and Kenny (2010) Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats. Nature neuroscience, 13, 635-641.

Drug use norms and expectations: Obsessions and compulsions in our society.

teensI used to always say, back in my using days, that speed (methamphetamine) was The American drug. Why? Meth makes its users sharper, more alert, and more focused, and it allowed me to spend entire nights up studying like I’d never been able to study before.

Unfortunately, like many other aspects of The American Dream, speed will also leave you spent before you know it, leaving the memories of those productive, focused, days far behind with little hope of coming back.

We live in a society that celebrates excess, be it in celebration or dedication to work, success, and achievement. Is it any wonder then that so many Americans turn whichever way they can to gain the edge that they feel they’re lacking when they compare themselves to those around them?

I read recently that many executives now keep a supply of medications like Adderall, Ritalin, and other attention deficit cures around for times when they need that extra push to stay up late and work.

We are skirting a dangerous line by putting out the message that everyone should be the best though of course, with no cheating… or at least no getting caught.

Teens are now using more and more prescription drugs while reducing, or at least not increasing, their use of many illicit, or illegal substances. How is this crisis we’re experiencing with our teens any different than the recent steroid stories exploding the mythic innocence of every American sport?

One of the things I want to inform my readers about in writing this blog is the process of addiction and the ways in which its development is often not under the control of the users, at least not the users likely to eventually develop into addicts. But, there’s also a different issue, the one having to do with what it is about our society that makes Americans so much more likely to turn to these substances in the first place???

It is estimated that more than a third (110 Million to be exact) of American have used at least one drug at some point in their lives. I don’t necessarily think that there is anything wrong per se with recreational drug use given the relatively low rates of addiction that develop from it. However, I think that drug use, even recreational use, that is meant to solve a problem or that is done as a normal part of life, is more likely to become problematic.

Some theories of addiction specifically assert that “self-medication”, as in using a drug to alleviate problems, especially psychological problems, can be a major indication of likely addiction potential. The problem is that the unsupervised use of the drug often does little to help the initial difficulties, and if anything, makes things worse as the drug user becomes more involved in the illegal drug culture. I probably don’t need to tell many of you about the social withdrawal and added psychological stress that goes along with becoming, or living with, a drug user.

My point is that we need to change the way we think about drugs in general. Drugs can be useful for many specific medical and psychological benefits, and possibly even for their recreational benefit (think Van Gough, or The Doors). But, in order to make sure that those we care about most don’t abuse and misuse drugs, we need to move away from the current attitude that seems to drive children and teens towards irresponsible, ill-informed, and dangerous drug use. By educating kids, not scaring them away from, the things that are dangerous for them.

You wouldn’t dream of teaching a child to look both ways before crossing the street by yelling at them that they better not EVER dream of setting a foot on the road without looking left first, would you?!

We teach our kids everything we think they need to know about life in order to prepare them for what’s ahead. Why is it that when it comes to drugs (and often sex), we shy away from bringing the subject up and still expect them to be well prepared when a friend says “Hey, want to pop one of these pills with me?”

There will always be those who for one reason or another are more likely to develop a problem with drugs regardless of how well prepared they are. Genetic influences on things such as low impulse control and sensation-seeking are known and are probably closely linked to some bad decision making. But even these people will benefit from being better prepared and more educated about their own choices so that when the time comes, even if a problem develops, they can hopefully acknowledge it, and deal with it, in a more capable, informed way.

We need to stop turning away from a problem and thinking it will solve itself. It’s time for us to look for answers and not rely on solutions appearing magically. They most likely won’t…

Question of the day:
Do you think that enforcement (of drug laws) or treatment (of heavy drug users)is the more effective way of dealing with the drug problem?