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Posts Tagged ‘stigma’

Shame on me – Stigma and addiction in treatment

July 12th, 2011

I keep hearing that back in the old days of addiction treatment, shame was the main motivating factor used by rehab counselors. Everyone admits that it proved to be a horrible motivator. It simply didn’t work! With all the advances in research into addiction, that must have changed, right?

I don’t think so. I see shame and stigma every time I hear an addict talk about their drug use. The shame is there in their eyes as they tell the stories of their trouble and the struggles of their recovery. Given the low rates of success in addiction treatment, the shame rests firmly in the inability to quit as well. A relapse is often seen as the ultimately shameful experience for an addict. The stigma of addicts as hopeless is rampant.

Still, we have evidence of genetic predisposition to drug abuse and addiction, we know of environmental factors that make it more likely that people will get hooked. The effect of many drugs on the brain make unsuspecting lab animals as likely to become addicted as any one of us and I’m pretty sure that shame doesn’t play a role in their process.

With all this evidence, why is the stigma of drug addicts still around? Why are they the only ones being blamed for their condition?

The evidence I cited isn’t that different from that known for cancer, yet we scarcely blame cancer patients for their disease. Even in the case of smokers who become ill, their is still sympathy for their suffering. So why are addicts different?

There are good addiction treatment options out there, as long as we don’t give up on the person and simply view their addiction as evidence of their weak character. Given the changes that long term drug use produces in the brain, it’s a miracle anyone recovers at all. We should be grateful for that.


Posted in:  Education, Opinions
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Recovery from addiction: Stigma and many obstacles, but no excuses!

December 11th, 2010

Many of the people in my life nowadays forget that I’m an ex-convict. Still, I get daily reminders that the “ex” part of convict doesn’t carry much weight. I also know that I have it easy because I have a Ph.D. after my name. For many others in recovery, things are even harder.

Still, when filling out job applications, considering possibilities for the future, or trying to start anything new, my past convictions are ready to jump out as the first hurdles.

Stigmatization after recovery from addiction

My first encounter with this sort of stigmatization came at my first job search after I got out of jail in 2003. I was applying for an Apple Store job and did well. Even though I told them that I’d been arrested on the job application, I got a second interview. Then the coveted email letting me know I was to report for training next week. Only the background check remained. But that final email never came. I never heard from Apple again and none of my emails and phone calls were ever returned. I can only assume that they found out that my arrest resulted in 9 felony convictions and decide to “pass.”

When I started at UCLA (no questions about felonies on school applications), I tried to volunteer at the Los Angeles Big Brothers and Sisters organization. I was rejected as soon as the background check was completed. People wouldn’t even let me volunteer and I had been drug free for over 3 years and attending a doctoral program at UCLA… It was frustrating to say the least

Being licensed is probably also going to be an issue if I want to become a clinical psychologist in the future. It was one of the reasons I didn’t try to go to medical school or law school. The hassle of having to fight for the right to work in my chosen field wasn’t something I was looking forward to. Apparently though while I wasn’t quite ready for the fight then, fighting addiction stigma is something I feel strongly about now. Between our “Anonymous No More” campaign and my efforts on and off the website, I think we’re going to be able to slowly move public opinion away from either the notion that drug use in itself is a terrible thing or that addicts are lepers and should be kept at a distance.

Recovery success, there is a life after addiction

Still, I am constantly reminded that success follows perseverance. When I’m told “No”, I feel disappointed, but I pick my head up as soon as possible (my great fiance often helps) and try to figure out another way in. That was true when I first set on my path and its true today. I’m proud of my achievements and by now, more than eight years after the last time I used crystal meth, they are many.

I know my worth, I believe in my purpose, and I’m not going to let anyone else hold me back. Yes I have nine felonies and I used to sell drugs for a living. But I’m done with that and I’m trying to do the best that I can.

I think my recovery is pretty damn good – I’ve got All About Addiction that is visited by thousands of people a week, more than a dozen publications and articles about addiction in professional and popular journals, and I’ve spoken at literally hundreds of sessions, classes, and conferences about addiction and the problems associated with it. If you believe in yourself, you need to think the same of your own work. Stay on the right path. Don’t let anyone stop you.


Posted in:  Addiction Stories, For addicts, Opinions, Tips
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About Addiction: Alcohol, drugs, and bipolar disorder

November 11th, 2010

Have any questions about different drugs or alcohol? We bet you do and we’re glad to see you back at All About Addiction ! You should browse our content and check out the information on alcohol, heroin, marijuana.  It is a great source for a quick 30 minute information session.

“Traditional” Drugs

BBC– A man in England was killed after consuming heroin that contained anthrax in it. This was the fifth case of a drug user in England who became ill due to anthrax. It appears that drug users are becoming increasingly vulnerable to having their contraband contaminated with anthrax.

Join Together– Do you think Marijuana should be legalized? That was the question on the minds of many individual’s as they went to the polls on Election Day, yet despite the concerted efforts of some people Proposition 19 was defeated. Some of the arguments for supporting the legalization of marijuana was so that it would be treated like alcohol and tobacco and would not be criminalized along with drugs like heroin, meth, and cocaine. Apparently the majority of voters thought those benefits didn’t outweigh the possibility that legalizing marijuana would increase social problems. By the way, this is not the first time Californians have rejected the legalization of marijuana, it also occurred in 1972, which likely means that some of the people who voted against it this time supported it in the past.

Synthetic Drugs and new drug combinations

KTLA-How does a drink of prescription cough syrup, soda and jolly ranchers sound to you?  Although this may be unappealing to some it is actually a drink bar-goers are getting in to. The drink is also known as Sizzurp (I’m pretty sure I’ve heard Snoop Dog say that in song) and can produce quite a high thanks to the codeine that is found in it. Unfortunately, the combination of alcohol and codeine also increases the chance that the drink will be deadly deadly. Apparently this drink is often promoted by individuals in the music industry and the DEA is worried and wants to crack down on it.

Addiction Inbox– If you would like to learn about a new drug called Mephedrone then this article is for you ! Mephedrone is a new synthetic drug found mostly in England. For more on this topic check out Dirk’s article!

Alcohol: Working Mothers and Energy Drinks

Marin Institute- There has been a growing recognition of the risks of alcoholic energy drinks and officials across the country are starting to take action against them (who hasn’t had a RedBull and Vodka?). Often times these energy drinks are marketed to youth but those individuals do not know the stress that high amounts of alcohol and caffeine can have on the body. Since 2008 major companies such as MillerCoors, Anhueser-Busch, and InBev have removed caffeine from their brands, but smaller companies have begun marketing even more dangerous products that come in larger sizes with higher alcohol content. The news media is attempting to educate the public on the dangers of these products and legal action may even be taken. Check out this article for a great read!

CNN– Working mothers have a lot to balance in their daily lives from running kids to school to doing errands and keeping houses and lives in order – it’s a tough job (just ask my wife). The magazine Working Mother found that 40 percent of working mothers turn to alcohol to try to alleviate stress and 57 percent reported misuse of prescription drugs. Check out this article to find out more and to watch a video which discusses this fuller details and don’t forget to look at some of our content on moderate alcohol intake.

Mental Health and Addiction Treatment

Breaking the cycles– It has often been reported that individuals who have certain mental health problems such as bipolar disorder have a greater chance of developing substance abuse problems (to alcohol or drugs). This article is very helpful in providing the families of individuals with bipolar disorder information to understand the disorder better as well as the alcohol and or drug abuse than may come with. With this understanding the families of these individual can help reduce the stigma of both the bipolar disorder and their addiction.

Addiction Information– Do you remember a couple weeks ago when All About Addiction reported that Michael Lohan wanted to open up his own rehab center? Well the apple does not fall to far from the tree because Lindsay Lohan now wants to open up her own rehab center.  Lindsay has been in and out of rehab five times in the past two years – Is this too early for her to open up a rehab center? I think that’s probably true and that she should focus on getting herself healthy first.


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

November 7th, 2010

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.


Posted in:  Opinions
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Addiction stigma – Making addiction recovery, and addiction treatment entry, even harder

October 13th, 2010

When people think about drug addicts, they often bring-up the negative stereotypical hippie, or homeless, image that movies, television, and much of our daily experience has left us with. Its usually not a successful business man, doctor, or lawyer that comes to mind.

This is an issue because many addicts attempt to disassociate themselves from this negative stigma, often resorting to denial of their drug problem or secrecy coping,  and not seeking the addiction treatment they need.

The truth is that addicts are found in every socioeconomic class and within every ethnic group and gender. On this site we have talked about doctors with addictions, the reality of behavioral addictions, and the science behind the compulsive behavior that addicts are so well known for. We have attempted to destroy myths about addictions, by informing our readers about the neuroscience of addiction, and allowing people “to come out” about their addictions. By doing this we hope to encourage openness about addictions, and not allow stigma to get in in the way of recovery.

Addiction stigma hurts addiction treatment success

The center for Addictions and Substance Abuse Technologies, at The University of Nevada, did a study on the affects of stigmatization on 197 drug users. The findings indicated that there is a direct correlation between the degree to which drug users are perceived negatively (stigmatized) and whether or not they overcome their addiction. The study suggested that addicts become more dependent on the substance they use because of the stigma (actual or perceived).

Researchers looked at six questions regarding stigmatization which were:

  1. To what degree do drug users experience stigma?
  2. Were the metrics of stigmatization conceptually distinct?
  3. Is the perceived stigma related to the number of previous addiction treatment episodes?
  4. How does secrecy as a coping strategy affect drug users?
  5. Do intravenous drug users have higher levels of perceived stigma than non-intravenous users?
  6. Do people with current contact with the legal system report higher levels of stigma?

The study found that there are varying degrees of stigmatization and that the most prevalent stigmas were; drug users felt that people treated them differently after finding out about their drug use (60%), felt that others were afraid of them when finding out about their drug use (46%), felt some of their family gave up on them after finding out about their substance use (45%),  felt that some of their friends rejected them after finding out about their substance use (38%), and felt that employers paid them a lower wages after finding out about their substance use (14%). My own personal experience certainly supports the first three findings – I have encountered people who stopped talking to me after finding out about my drug addiction past, and during my addiction there were long stretches of time during which my family completely gave up on the possibility that I would ever recover. At the time I simply shrugged these things off and pretended like they didn’t matter, but they certainly didn’t give me a good reason to stop using drugs.

The results of the study indicated that the measures of stigma are conceptually unique. These measures included Internalized shame Perceived stigma, and stigma-related rejection, all of which were correlated with one another to some extent.

Users with a higher number of addiction treatment episodes also engendered higher levels of stigma and had a more difficult time succeeding in treatment. These results  support earlier findings (Sirey et al. 2001) that showed that users with higher levels of perceived stigma were more likely to prematurely discontinue treatment, confirming that stigmatized drug users are not likely to seek addiction treatment and are more likely to relapse after starting treatment.

Addicts have a sense of shame associated with seeking treatment for their problem

The current addiction treatment system has produced a seeming paradox within the mind of the struggling addict – By owning up to their addictions, addicts reduce the invisibility of the problem, helping others claim back their lives from the secrecy of substance abuse and behavioral addictions. Unfortunately, that process takes far longer than the stigma the confessing addict has to immediately confront.

The study showed that secrecy coping is associated with lower quality of life because of the drug user’s inability to openly discuss their addiction. Subjects  that dealt with their addiction alone had poorer mental health, decreasing their chances of recover due to the stigma of addiction. Much like with many other chronic mental, and physical, conditions, the stigma attached to addiction, and addiction treatment seeking, can often lead to poorer outcomes in the long run and less successful treatment development due to low participation rates in the kind of groundbreaking research necessary. By reducing the shame associated with confessing to an addiction, society could drive forward the advancement of addiction treatment, helping us treat addiction like we treat cancer, parkinson’s disease, and many other chronic diseases.

Surprisingly the results from the study showed that the legal system does not increase the  level of stigmatization, yet subjects that used intravenous drugs felt a higher level of stigma.

Citations:

Sirey, J. A., Bruce, M. L., Alxopoulos, G. S., Perlick, D., Raue, P., Friedman, S. J., et al. (2001). Perceived stigma as a predictor oftreatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158, 479−481.

Luoma J.B., Twohig M.P., Waltz T., Hayes S.C., Roget N., Padilla M., Fisher G. (2007) An investigation of stigma in individuals receiving treatment for substance abuse.


Posted in:  Anonymous No More, Education, For others, Tips, Treatment
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Trauma and Addiction – The often ignored reality about addiction

September 22nd, 2010

In previous post, I’ve talked about some of the links between addiction concepts like cravings and trauma disorders like PTSD (see here). The reality is that there is a closer link between addiction and trauma that is often overlooked.

I spend a lot of time on this site covering some of the neuroscience that explains why the repeated use of addictive substances can lead to the kind of behavior that is so common in addiction. Still, most of that neuroscience ignores the portions of a person’s life that come before the actual drug use. The one exception would have to be all my writing on impulsivity, and some work on the relationship between early life stress (or trauma) and depression, which is known to be associated with drug abuse.

The way I see it, there are at least 3 distinct stages to addiction :

  • What happens before drug use.
  • What happens once chronic drug use begins.
  • What happens once a person stops using.

Though we often like to pretend otherwise, trauma is a common part of the first stage.

How do we define trauma?

In this context, trauma is any event that affects a person in a way that can be seen to have caused a substantial, long term, psychological disturbance. The key to this way of looking at trauma is its subjective nature.

Things like divorce, bullying, rejection, or physical injury can all be considered traumatic if the subjective experience can be thought to conform to this definition. Anything counts as long as it leaves a painful emotional mark.

While we’re all pretty adapt at covering up such trauma, the emotional pain often needs to be soothed and a good way to soothe it is with drugs that make it temporarily go away. The first drink of alcohol, or hit of some other drug, will often take care of that.

The reality of early trauma and addiction

Some call the experience of covering up the pain of trauma with drugs “self-medication” (though the term also applies to other situations), some dislike the term, but I think the fact remains that often, emotional pain can begin a search that often leads to risky behaviors and drugs.

I’m nowhere near calling self-medication the only reason for drug abuse as some others do, but I think it’s an important factor and one that can’t be ignored. As the stigma of emotional pain, or emotional responding in general, is reduced, people’s ability to deal with such pain in a healthy way should lead to a reduction in seemingly helpful, but ultimately self-destructive behaviors.

One of the most useful roles of psychotherapy for addicts is in dealing with the trauma in a healthy, constructive manner. This way the shame, guilt, and other negative emotions associated with it stop guiding the person’s behavior. While this is rarely enough to stop the need for self-medication by itself, it can be a very useful part of a comprehensive treatment plan. It’s important to remember that once someone has entered the realm of chronic drug use, there are brain and body changes that can often trump whatever the reason for beginning drug use was.

The ignored reality about addiction is that it often has an origin in behavior and unfortunately, trauma is often that starting point.


Posted in:  Education, Opinions
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Addiction stories – Anonymous no more: Sarah’s recovery is no secret

July 18th, 2010

In case you haven’t noticed, I can’t stand the stigma I’m supposed to carry around as a recovered addict. People expect me to steal from them, or pull out a gun, or maybe just smoke some crystal meth at the dinner table. But guess what, I haven’t been that guy for almost 10 years now, and chances are, I’m never going back there again.

I received the following addiction story from a reader, another recovered addict (from an eating disorder mostly) apparently sick and tired of the misconception. I’m publishing it here with very few changes, and though I’m including it in our Addiction Stories category, I’ve started a new category now and it’s called Anonymous No More. It’s my personal opinion that if more recovered addicts stood-up and told the world that their previously sordid lives are now full and complex, just as they are meant to be, we’d see a lot less of the kind of misjudged treatment Sarah is referring to. So thank you Sarah Henderson for being the first one up to bat on All About Addiction. And here’s to all those who are going to follow everywhere – There’s no doubt in my mind that when it comes to inspiration, addiction stories do as good a job as research-based education.

Anonymous No More: Inside Stigma – A Patient’s Perspective

Hi, my name is Sarah. I’m Anorexic, Bulimic, and a Cutter.

You could call me these things. But they wouldn’t be accurate. Because I am not these things, these labels. And I am not in recovery from these things.

I am recovered.

From those things, I am recovered. I am bipolar, which requires ongoing management. But you wouldn’t know it if I didn’t tell you. I am not the stereotype, I am not the crazy person we all think of, ranting and raving on some street corner. I am like anyone else, except I take a few pills before I brush my teeth in the morning.

And yet.

I still catch flak all the time. For the taking meds, for going to therapy, for the eating disorder history, for the visible scars from years of cutting. People comment on them, I’ve lost jobs because of them. It’s like, what do you want? I used to cut myself. I don’t anymore. I used to starve and binge and purge. I don’t anymore. So eat lunch with me and stop looking at me like I’m going to vomit on the table any second. Deal with me as I am now, not as I was then.

And yes, I take medication for a chemical imbalance. Guess what? So do diabetics. Only their imbalance is in the pancreas, and mine is in my brain. That’s the difference that makes people freak. That’s where the stigma lies.

If you ask a poet, he’ll tell you the seat of the soul lies in the heart. If you ask a neurologist, he will rightly tell you that the seat of the soul lies in the brain. And anyone who’s ever experienced dementia will testify to that. It’s very possible to exist in your body without living in it. And it’s possible for the person you love to die long before their heart stops.

I believe that stigma comes from people’s instinctual knowledge that when you mess with the brain, you mess with the soul. It can be disturbing, it can be terrifying, it can be cruel. And most people just aren’t up for facing that. However, when you don’t face it, you also miss out on everything the other side has to offer: healing, resilience, clarity, and courage. And while they are some people who don’t come back from mental illness, the vast majority of us do. The other side is a beautiful place. And if you can get past the stigma, you can join us.

Closing “Addiction Stories” commentary from Adi

You’ll notice that Sarah considers herself a recovered addict. When it comes to my own drug use, I do the same, and I can tell you that there are quite a few people out there who strongly dislike it when I tell them that I think I’m done with my drug addiction. To me, this is all part of the same stigma equation – It doesn’t matter if others in recovery stigmatize you as having a problem for life or if the people doing it to you are ones who have never walked in your shoes. The bottom line is that I believe people can be “recovered” and though it probably doesn’t apply to everyone (nothing ever does), I think it likely applies to more people than you believe.

And that’s where working through the stigma is important, as we shed off the shackles of our current understanding and get to a clearing that is lighter and offers more freedom for each addict to use the tools that make the biggest difference for her. That way she can live her life after her recovery as she wishes with little judgment and consternation from those around her. And it shouldn’t matter if we’re talking about recovery from an eating disorder (like anorexia or bulimia), drug addiction, gambling, or sex addiction.

Doesn’t that sound nice?


Posted in:  Addiction Stories, Anonymous No More, Food
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