Keep your head up – no shame in addiction

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

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

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

Higher drug abuse among gay youth likely tied to rejection

For a lesbian, gay, or bisexual youth, “coming out” is an extremely stressful, though important event that can result in improved self-esteem, social-support, and psychological adjustment.

However, a recent study found that the reactions to such a disclosure have a lot to do with the risk of those youths abusing alcohol and drugs.

Social rejection and drug abuse among gay youth

The results revealed that the more rejecting reactions a youth receives, the more likely they are to engage in drug abuse including alcohol, cigarette, and marijuana use. This was true even after researchers controlled for a number of other important variables like emotional distress and demographics (race, ethnicity, education, socioeconomic status, etc.).

This makes a lot of sense. After finally deciding to go through with such a monumental disclosure, harsh rejections likely cause some serious damage to a youth’s self-esteem, making escape by drugs an attractive option. Although coming out can eventually lead to increased self-esteem even for this youth, the road there is not an easy one.

The good news was that accepting reactions seemed to protect youths from the harmful effects of being rejected – Social support helps!

The researchers suggested that drug abuse prevention attempts with LGBT youths address the impact of rejecting reactions to sexual-orientation disclosure directly in order to hopefully reduce their negative impact.

Here’s a video about the difficulties of coming out in high-school:

Reference:

Rosario, Schrimshaw, & Hunter (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23, 175-184.

Drug abuse and teens – The adolescent addiction challenge.

Guest author: Clint Stonebraker

teen-smokingRecovery from any addiction is a difficult process. It involves an individual’s willingness to take responsibility for his or her actions, a concrete decision to make significant lifestyle changes, and the courage to repair damaged relationships. The level of emotional maturity involved in taking these steps is usually somewhat foreign to an addict.

What about a person who is suffering from addiction and is, developmentally speaking, still a child? How does this person muster the emotional maturity needed to begin the recovery process?

I had the opportunity to work with a seventeen year old whose father had recently been treated for alcoholism. The father had suffered numerous consequences related to his alcohol problem including multiple D.U.I.’s and a divorce. By the time he sought treatment, the father was motivated to make a life change. He understood the root of his life problems revolved around alcohol abuse and had a desire to take responsibility for his actions.

When it came to the son, things weren’t that simple…

The seventeen year old had also suffered numerous consequences related to his drug abuse. He had already been arrested twice and had left home four months prior to seeing me. In fact, he clearly stated the only reason he agreed to the appointment was because his father had made it a part of the criteria for the boy to come home. He still believed the problems in his life were due to others not “leaving him alone.”

teensFor decades the adolescent substance abuse problem has gotten progressively worse. There have been prevention programs which have had some success, but adolescents continue to abuse drugs and alcohol at an alarming rate.

Because of this, it is important for anyone who works with adolescents to understand this unique population:

  • The conscious motivation for most adolescents to abuse drugs and alcohol is different than that of an adult. An adolescent who engages in substance abuse is seeking fun and peer acceptance, whereas the adult is seeking pain relief.
  • In most cases adolescents have yet to face the same level of physical or emotional consequences most adult addicts have faced
  • The adult addict is responsible for all aspects of his or her life, the adolescent isn’t

These are just a few of the differences between adults and adolescents with substance abuse issues. Some of the challenges in treatment include:

  • Creating an environment in which the adolescent has fun and gains peer acceptance. Developmentally these are needs which must be addressed
  • Helping an emotionally immature child take enough internal responsibility for his or her actions to be motivated to change
  • Showing an adolescent how to maintain healthy balance in his or her emotional life, in other words, limiting the emotional extremes

The biggest mistake clinicians make in treating adolescent substance abuse is assuming the adolescent is capable of dealing with life like an adult. In most cases, an adolescent must be able to see recovery as an attractive lifestyle. An adolescent substance abuser already has a general lack of trust with adults or any other “authority” figures. It is critical to maintain patience in order to gain the trust of an adolescent. Once trust is established, it is possible to reach an adolescent at their level.

When it came to this seventeen-year-old son, I knew that in order for this young man to begin the recovery process, he would need to see sobriety as an attractive lifestyle choice. I was aware of a group that held regular support group meetings specifically for young people. They also facilitated social events on the weekend.

As a part of the therapeutic process, I included his involvement with this group. The combination of counseling and a peer support system gave this young man a comprehensive plan of action.

As a result of beginning to associate sobriety with feeling good, he became more responsive to counseling. Over time he began to take more responsibility for his actions. He had a group of peers with whom he was accountable, could have fun, and network.

His father was involved in this process through his own counseling and involvement in a parent support group. Over time this young man was able to stay sober and reacclimatize himself into society.


This story illustrates key components of a process of recovery for adolescents. Over time an adolescent can begin to see the consequences of his or her actions. It is important to keep in mind what adolescents respond to. It is not one element that provides the key to adolescent recovery. It is the combination of therapy, peer support, and family involvement which provides the best opportunity for an adolescent to recover from addiction.

If we want to weaken the connection between teens and drugs, we have to start using what works.

Releasing the motivation bottleneck – Helping addicts by making recovery easier

My friend Patrick as SpiritualRiver reminded me of an issue that I think is somewhat obvious to many drug addiction researchers but may not be to others.

The way I see it, there is a specific reason behind much of the research into medications, or other interventions, that will help drug addicts in their transition to recovery:

If we can figure out a way to reduce the extreme hold that drugs have over addicts, we may just make it possible for a much larger proportion of them to get their life back and succeed in addiction treatment.

Long term drug use causes some serious alterations in the neurological functioning, and therefore the behavior, of substance abusers. As it stands, it requires a great deal of motivation, support, and perseverance to overcome a serious drug habit.

Still, if we can somehow make it easier, either by intervening earlier, or by somehow speeding up the brain’s recovery, or by creating the kind of functioning needed for the person to be able to make deliberate, informed decisions, we could just even the playing field a little. Right now, there are some medications out there that do just that, and as far as i’m concerned, regardless of what people say about substituting one addiction for another (which they do for methadone and buprenorphine), if we can get addiction back on the road to a functioning, contributing, life – that’s recovery too. Harm reduction is just that, a way to make people’s lives easier even if they can’t, or aren’t ready, to completely give up drugs. I for one don’t understand why so many people are insisting that it’s all or nothing. In case you haven’t figured it out, that’s not how life normally works, in recovery or anywhere else.

And by the way, that’s definitely not the only way to intervene – medication like modafinil and other pharmacotherapies that help addicts make better, less impulsive choices, also work; add to that bupropion (an antidepressant and a nicotine addiction medication that has a low abuse potential), as well naltrexone (good for opiate overdose but also for alcoholism treatment) and you begin to see that this area of treatment is getting better at providing solutions that are meant to supplement, not replace, traditional treatment modalities.

The end goal is to help the addict and as I’ve said before, I think we should use all our tools.

What makes the 12 steps (and other social support groups) a good part of addiction treatment aftercare?

I’m not a devout 12-step believer, though I think that AA and the offspring programs have some serious merit, especially when it comes to addiction treatment aftercare. In this discussion, I’m talking about all group-support based programs, including Smart Recovery and others. I’m personally a fan of non-religious groups, but that’s just me.

Chronic conditions require long term care

I’ve already talked about my view of addiction as a long-term, chronic condition. Regardless of the “disease” moniker, I think it’s undeniable that, at least for some people, addiction treatment needs to continue long past their initial “quitting” phase, regardless of whether they went through an inpatient or outpatient treatment (or quit alone at home).

Without getting hung-up on my misgivings about 12-step programs (I have a few), I’d like to talk about some of the factors that make me believe in the system as a continuous aftercare resource:

  1. It’s free – Most people, especially given current insurance limitations, can’t afford ongoing outpatient help be it through a psychologist or an addiction-treatment provider. While the latter two are can be superior in their knowledge about recent developments in addiction, they cost money.
  2. It normalizes behavior – One of the difficulties many addicts share is in talking to non-addicts about their problems. They feel ashamed, misunderstood, or judged. Being with like-minded individuals can eliminate some of those issues. Nevertheless, people often find understanding only regarding the specific issue a program deal with and therefore find they need to attend many different support groups to address all their issues.
  3. It provides ongoing support outside of meetings – The social connections people make in meetings can often help them outside the rooms. Your psychologist isn’t likely to do the same.
  4. It keeps the focus on relevant issues – When following the 12 step rigorously, one is always working on bettering his/her program. That sort of attention can help catch problems early on before they develop into real difficulties.
  5. It keeps people busy – Some addicts need to stay occupied to keep out of trouble, especially in the transition from their acute treatment back to everyday life. Attending social-support meetings can make the time go faster while providing a relatively safe social environment.

Even with all these advantages, I can’t help but object to some of the AA dogma, especially when it comes to religion and to the unwavering resistance to adapt their system as it was handed down in the late 30s. We’ve learned a lot since and I think 12-Step programs could benefit greatly by incorporating recent knowledge. In fact, reviews of studies regarding the effectiveness of AA find it no more useful than other interventions overall. This is why I believe that 12-Step programs are best used along with, and no instead of, additional treatment options.

Citation:

Cochrane Review – Alcoholics Anonymous and other 12-step programmes for alcohol dependence

About addiction: Weed, early recovery, teens and alcohol, and robotripping

We started this thread last week and I’m going to do my best to keep it up. Here are some links you may find useful on other blogs:

The Addiction News Network – Brain damage in young adults who smoke weed

Spiritual River – The usefulness of social support in early recovery

Breaking the Cycles – A great post about talking to your children about alcohol

Recovery Basics – Robotripping (Or Roboing as we used to call it) is apprently coming back

I hope you enjoy those as much as I did.