The hopeful side of my addiction – Drug use is not always a dead end street

I was sitting around with some friends last night talking about old times over dinner.

I think it’s sad that the most commonly seen face of addiction and of drug use in general is that of failure. We see it on the news, in the tabloids, and it seems to seep into our minds.

I guess it shouldn’t be surprising given the overly negative tone of the media in this country overall, but as I was talking with my friends last night, it dawned on me:

Even though we’ve all seen the uglier side of life, even though some of us made it down to a place those around us thought we’d never come back from, here we are, well and healthy, and back on the other side.

As I’d mentioned before, I’m working on a book that details my travels down the rabbit hole and back. Last night was proof that these stories need to be heard. Although coming back from drug use, even heavy use, even addictive use, is not easy; it is possible, even common.

I’m sick of the stigma of “lost cause”, especially because I think it’s so unjustified. There are so many that walk around us having conquered what most still think is a death sentence. It’s time to dispel the myth.

Surfing and exercise in crystal meth addiction recovery

Hey everyone, I’ve already talked about the endless ways in which exercise can help addicts, especially in early recovery, fill the void left by their drug use (see here for some articles).

This NY Times article follows Darryl Virostko, a world class surfer, as he attempts to incorporate surfing and surfing lessons into the rehabilitation efforts of Southern California addicts.

Darryl was himself addicted to crystal meth. Another proof that recovery is possible through many different routes.

Addiction causes – Drug addiction as a chronic disease makes sense

The stigma of addiction is alive and well. Whether you believe in the disease model or not, it seems that people’s judgments regarding what it means to be an addict are well entrenched.

I’d like to work on that a bit.

Why is addiction a disease?

In numerous posts on this site I’ve addressed issues like genetic predisposition and the effects of drugs on the brain that impair addicts’ ability to control their choices. A disease is commonly defined as “A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” (See Answers.com) I don’t think there’s a question regarding whether or not addiction involves a pathology of a body part, namely the brain.

It would definitely be easier if we could all just say that addiction is the product of bad choices. Nevertheless, all the science I’ve seen points to the fact that addicts have impaired decision making to begin with that is only made worse by the drugs they take in.

A comparison with Diabetes

diabetesFor some reason, this still leaves a lot of people seeing addicts as the only ones to blame. I’d like to try a different approach:

We’ve all heard of type 2 diabetes. It’s the kind people aren’t born with, but rather are develop later in life. Most cases are the result of an over exposure of the body to sugars that breaks down its ability to produce insulin, leading to the disease. There are an estimated 15 million people in the U.S. who have type 2 diabetes. They make up 90% of diagnosed diabetes cases.

I think that type 2 diabetes is a disease that can help many reformulate the way they think about addiction.

Patients with adult onset diabetes likely have genetically reduced insulin receptor functionality and possibly other factors that increase their likelihood of developing the condition. They also likely consume more sugars than people who don’t develop type 2 diabetes, though the exact causes are still uncertain. Nevertheless, with early detection, the disease progress can certainly be slowed and perhaps even halted. As the disease progresses, the body’s response to sugar is altered, eventually resulting in what looks like a severe alergy to sugars. However, once developed, type 2 diabetes patients often require similar treatment courses, including medication, exercise, and dietary changes that patients with type 1 diabetes (the type present early on in life). At this point, simply cutting back will no longer do.

This is not all that different from addiction.

Addicts are often born with a set of genetic and environmental factors that predispose them to impulsively engaging in and seeking out, risky, exciting activities. Moreover, the addict’s reaction to drugs is often different than that of non-addiction-prone individuals. For example, many stimulant abusers report a calming, rather than excitatory, effect of drugs like methamphetamine, cocaine, and the likes. That was certainly my experience back in my crystal meth days.

It is true that here the predisposition is more abstract, since it resides in brain activity patterns, but as I’ve said many times before, the brain is certainly a physical part of the body and should be treated as such. Like diabetic patients, once addicts begin using the drugs in large quantities and for extended periods, the drugs cause alterations in physical systems. Like diabetics, once these changes occur, they are certainly long lasting, if not permanent. Dopamine function in the brain of crystal meth abusers has been shown to take as many as 2 years to return to anything resembling non-user levels and we have no way of telling if the newly formed dopamine activity is at all related to what was previsouly there. Once the disease we know as addiction (or dependence) takes hold, there are specific recommended treatments that need to be followed. Simply cutting back will no longer do.

The bottom line?

Addiction fits the model of a disease as well as many other conditions. I have no doubt that people’s moral judgments get in the way sometimes and make it hard for them not to fully blame an addict for their trouble. I don’t doubt that addiction can only develop with the use of drugs, but if there are pre-existing conditions that make that use more likely, I think it need to be taken into consideration as well.

Always stay mindful – My different experience with recovery, addiction, and crystal meth

One of the main features of addiction is, unfortunately, how insidious it is.
Given everything I’ve been learning in the past 12 years about drugs, their abuse, and the people involved, I feel right in saying that most people don’t realize how far gone they are until it’s too late.

I consider myself fortunate in finding my way out of my crystal meth addiction, and I’ve met many others who’ve found their way as well. Still, I realize constantly that you can’t be too vigilant or too aware in watching out for inroads back to disaster.

My Experiment

methAs I’d said before, I began drinking again after 3 years of staying completely sober. My decision to leave typical recovery was made after talking with my parents and loved ones and making sure that they understood what this meant. I made sure that if I began reverting back to my old way of being lazy, aloof, and disrespectful, they would step in and send me right back to rehab.

This was my way of running the famous AA experiment and for me, it’s been working for the past 5 years or so.

But, I am always aware of how intoxicated I am and it is rare nowadays that I let myself get to the point of the loss of control. I have this constant voice in my head now that monitors how drunk I feel. I DO leave unfinished glasses of wine at dinners at times, and I do my best to make wise choices before going out so that I don’t make dumb ones later (like driving under the influence).

How I stay grounded

Still, most of my awareness about my addiction and what it means comes from my constant work in the area. Working with people who are in the throws of their disease keeps me in touch with how far I’ve gone and how much I don’t want to go back. I now know much more about the risks and about what I’d be doing to myself were I to take them. I don’t want to kill additional neurons, and I sure as hell don’t want to go through 2 more years of hell trying to put my life in order. I’ve never tried speed again since the day I quit in 2002 because I can’t say that I’m sure of what would happen next, and I don’t want to find out in case it’s bad…

This is why I believe that education is one of our best weapons in the battle against addiction.

My most valuable help

Lastly, I feel like one of the most important ingredients in all of this is having people you can trust and confide in. I don’t have many of those, but there are a few, and my family is always there, and I share everything with them.

For me, it was the moment I chose to be forthcoming with my family and hide nothing from them that has healed years of tension, mistrust and fighting, and I never want to go back .

This however means that they too have to be open. We now laugh when I say things like “I wish I could do some speed now to get me through all this work I have,” but I assure you, no one was laughing 5 years ago…

A word of caution

DefeatedMy sponsor in AA “went out” (meaning he started using again) a few months ago after being prescribed pain medication for surgery. Many in AA would point to the fact that he should have never been prescribed those pills in the first place. Everything I’ve learned about the brain indicates that automatic relapse is only likely when using one’s “drug of choice“. I say it was the dissolution of his marriage and his trust that having been sober for 12 years he could do no wrong that got him in trouble.

The moral:

Be open, accepting, and loving. Let those around you say things that make you uncomfortable without too much judgment so that they feel safe in coming back to you, and if they ask for help, know how to give it to them. No matter how happy people are to finally quit drugs (or another addiction), the feeling of defeat when they realize they now have to learn to live without their crutch can be enormous. This is where the help is most important.

Question of the day:
Do you have a story about the support you found necessary for your own recovery or the recovery of someone close to you?

Addiction-brain effects: Sex addiction, neurotransmitters, and being love addicted

***A disclaimer: Sex addiction is a relatively new concept in science. I haven’t been able to find much research on the subject, so much of what is being said here is my interpretation of the current literature on sexual responsivity in humans.***

sexI’ve already mentioned that scientists are beginning to consider behavioral addictions (like gambling and sex) as being similar to drug addiction. We’ve also covered sex addiction on the site quite a few times.

Since we’d covered the addiction-brain effects of some of the major drugs’ (see here for opiates, crystal meth, and cocaine), I thought it’s time to write about the possible science behind sex addiction.

The sexual activity cycle

Scientists have divided human sexual interaction into 4 stages:

  1. Desire – Represents a person’s current level of interest in sex. It is characterized by sexual fantasies and a desire to have sex.
  2. Arousal – Includes a subjective sense of sexual pleasure accompanied by a physiological response in the form of genital vasocongestion, leading to penile erection in men and vulva/clitoral engorgement and vaginal lubrication in women.
  3. Orgasm – Involves both central processes in the brain and extensive peripheral effects. Orgasm is experienced by the peaking of sexual pleasure, release of sexual tension, rhythmic contraction of the perineal muscles and pelvic reproductive organs, and cardiovascular and respiratory changes.
  4. Resolution – The final stage of the normal sexual response cycle. There is a sense of release of tension, well being, and return of the body to its resting state.

After sexSex addicts don’t seem to have a problem with stage 3, and resolution is more like the end of sexual behavior. So we will focus the rest of our attention on the other stages 1 and 2.

Sex and neurotransmitters

While sex doesn’t involve the ingestion of substances, each of the above cycles does involve the release of many of the neurotransmitters we’ve already discussed (dopamine, serotonin, etc.).

In fact, there seem to be three major area in the brain that are activated during sex:

  1. The Medial Preoptic Area (MPOA) – This is one of the areas where all the sensory inputs to the brain converge. This. This area is crucial for the initiation of sexual response – the move from desire to arousal. It is mostly the release of dopamine within this area that supports sexual responding. Animals with lesions here can’t  mount or thrust.
  2. Paravantricular  (male) or ventromedial hypothalamus – These area are responsible for non-contact sexual responses. Dopamine is once again the main activating agent here.
  3. The mesolimbic system – Important for the motivation towards anything “good” this system is also very involved in motivation for sex, a big part of the desire and arousal stages. As with drugs, it is the release of dopamine with this system that increases the motivation for sex.

We haven’t discussed the first two area much, and from my understanding, their functioning is relatively specific to sexual response. However, we’ve certainly mentioned the mesolimbic system. This is the same system involved in the brain’s processing of opiates, cocaine, methamphetamine, and essentially all other drugs. It is also the system in charge of food motivation.

As you can see, dopamine is an activating neurotransmitter for sexual response. Serotonin on the other hand, plays an inhibitory role in sex. Through its activity on a number of brain area, serotonin reduces desire, arousal, as well as the ability to orgasm. The increase of overall brain-serotonin levels is one of the main reasons for reduced sexual responsivity in individuals who are taking SSRI antidepressants.

What about sex addiction?!

Aside from a few specific authors (like P. Carnes), scientists still find themselves struggling with whether or not behavioral addictions should be considered similar to drug and alcohol addiction or whether they are examples of compulsive, or impulsive, behaviors. I personally believe that these all share more common features than we may yet realize.

Nevertheless, for addicts, the subjective experience of a substance, or behavioral, addiction is similar. It is an inability  to control a behavior in the face of repeated negative consequences that is often accompanied by a need for more and a reduced sensitivity to the act.

Given my recent reading on the brain processes involved in normal human sexual response, I’ve developed my own early theory about sex addiction:

Given that many of the same neurotransmitters are involved in the regulation of sex, it is my belief that sexual addicts or those experiencing sexual compulsions, fall into one of two categories that probably overlap to some extent:

  1. Individuals who have reduced inhibitory capacity (like those with impulse control disorder, ADD, or ADHD for example). These individuals find themselves acting out relatively impulsive behaviors that others without such dysfunction seem to effortlessly control. Given what we know about impulse control disorders, it is no wonder that these individuals often find themselves engaging in more than one such behavior, including drug, sex, and other poossibly addictive activities.
  2. Those who’ve had sex paired with a strong neurological response – Given the important role of dopamine in all rewarding activities (what scientists call appetitive response), it is very possible that two or more rewarding experiences that are linked may increase the brain’s response to any of the individual rewards.

neurons that fire togetherLet me explain the last point: In neuroscience, there’s the concept that Neurons that fire together wire together,” which is to say that events that happen at the same time, if they are strong enough, may form their own neural networks. If something strongly negative (like violence) happens in conjunction with sex, the experience might lower sex responsivity. However, if a strongly rewarding event happens at the same time, the link might serve to enhance response for both future sexual experiences and the linked event.  The people in the first group are likely to often fall into this category due to their use of psychoactive substances. Drugs release huge amounts of dopamine, which may then become linked with sexual response, making sex seeking as strong as drug seeking.

So that’s my take, for now, on sex addiction. Like other addictions, it has to do with the exposure to a very rewarding event that in a subset of individuals ends up developing an exaggerated response or an inability to control it. Since feeling of love and intimacy can often be just as rewarding, people often refer to themselves as love addicted, and not sex addicted.

Sources:

1) A. G., Resnick, & M. H. Ithman (2008). The Human Sexual Response Cycle: Psychotropic Side Effects and Treatment Strategies. Psychiatric Annals, 38, pp. 267-280.

2) E. M. Hull, D. S. Lorrain, J. Du, L. Matuszewich, L. A. Lumley, S. K. Putnam, J. Moses (1999) Hormone-neurotransmitter interactions in the control of sexual behavior. Behavioral Brain Research, 105, 105-116.

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?

Beyond my addiction: Allowing myself to be proud of my achievements

This is a more personal post than I’m used to writing, but I think the thoughts in it are shared by many addicts, so I’d like to share it. I originally posted it on my personal blog:

It’s sad, but for the most part, I focus on the things I haven’t yet done and not on what I’ve already accomplished.

When I think about it for a few seconds, it’s staggering just how much I’ve managed to do in my 32 years here:

  • I spent my first 14 years having a wonderful childhood
  • I only let my obsessions during those years take over sometimes
  • I moved to a new country and made myself at home again
  • I dug myself out of a severe depression episode
  • I made it through college somehow in a haze of drinking and drug use
  • I moved myself out to Los Angeles without knowing a soul and made a life there
  • I’ve run a recording studio, a record label, and made my own music
  • I’ve DJ’d and put out two records
  • I’ve broken my leg and learned how to walk again
  • I held my head high through a brutal court case
  • I made my way through rehab, overcoming my addiction to crystal meth
  • I made it through months in jail
  • I’ve managed to stay drug free since those two events
  • I’ve gotten myself back into school
  • I received two Master’s degrees with endless honors and awards
  • I’m steps away from finishing my PhD
  • I’ve secured a book deal to publish my memoir/lessons from addiction (still struggling with the writing of that one)
  • I’ve published more than 10 articles, 2 book chapters, and given dozens of presentations at national and international addiction conferences
  • I found the love of my life and am working hard to make my damaged ego last through a real relationship

I often take these things for granted, but it’s good to write them down. It lets me know just how grateful I should be for even being here, let alone standing upright and proud.

I’m lucky.