Addictions, like snowflakes, have one thing in common – they are all absolutely unique.
The intricacies of a snowflake pattern can be an easy metaphor for the intricacies of human experience when it comes to trauma, addiction, resilience, success or failure. What makes one person reach for alcohol to deal with her social anxiety makes another person become a public speaker to conquer that fear.
A fortunate child growing up in a household filled with love, attention and given lots of opportunities to develop academically might not thrive at all, might drop out of school, and might become addicted to pills. Why? Too much prosperity? Some traumatic event at school? Or something that another person would consider trivial, like being made fun of at a party? Another sibling from the same family can go on to become a successful psychologist, a parent to a bunch of happy kids, but then will suddenly crumble in her 40s and start drinking. Why? Did something happen in her childhood that only surfaced when she reached middle age? And reversely, a woman who grew up in a single-parent household, surrounded by addiction and abuse and poverty, grows up to become a successful entrepreneur who enjoys wine but only as far as vintage goes and only by a glass.
The point I’m trying to make is that there’s really no way to predict what will turn someone into a person with substance use disorder and what will make another immune to it. For this reason, we cannot also make false and stigmatizing assumptions about groups of people who “tend” to suffer from greater incidence of problems such as addiction. We cannot develop any kind of sure formula that will help us identify those who might be more prone to addiction than others – this is not to say that research, and especially genetic research, should be ignored, as there seems to be a genetic component to addiction, but we cannot assume a child will grow up to suffer from substance use disorder even if both parents have had it. Sure, the child will have a greater chance of developing it, but she might also completely skip that genetic sequence and be entirely resistant to her genetic “fate.” I know of two sisters who came from the exact same environment and who would score high Adverse Childhood Experiences, and one of them has struggled with addiction for more than two decades where the other one has never gotten more than a little tipsy at a party (and, frankly, says, hates the effect that alcohol has on her).
It is only natural for humans to want to know the cause of illnesses, and especially something like addiction – so widespread a problem that it is now considered an epidemic. We think that if we know the cause, we will be able to eliminate it. That’s what we’ve done with infectious disease. Maybe there is a way to vaccinate people against addiction? Probably not. I tend to believe that substance use disorder is a condition so complicated that the physical element is just one of its many components – for those reasons I am skeptical about medication used to eradicate it. I don’t believe we’ll ever come up with the right formula because there are so many targets to aim for.
In his book In The Realm of the Hungry Ghosts, Gabor Mate talks about how we simply cannot compare each other’s pain or capacity to endure suffering. He writes, “People who have overcome severe addictions deserve to be celebrated, and they have much to teach, but their example cannot be used to condemn others who have not been able to follow in their foot steps.”
As the opioid crisis continues to rule news headlines, it can be easy to forget that alcohol still poses a serious problem to those who are addicted to it. April is Alcohol Awareness Month, founded and sponsored by the National Council on Alcoholism and Drug Dependence. Its purpose is to spread awareness and education to the public to shatter the stigma that so frequently surrounds alcoholism while increasing understanding and acceptance of alcoholism as an illness.
Alcoholism is particularly common among individuals who suffer from a co-occurring mental illness. While studies vary regarding the comorbidity between depression and alcoholism, there is certainly evidence that individuals who suffer from major depressive disorder are 2-4 times more likely to suffer from an alcohol use disorder than those who do not. In addition, Individuals who suffer from an alcohol use disorder are twice as likely to suffer from depression in their lifetime. Regardless of whether depression or alcoholism appears first, each condition commonly perpetuates the other.
For me, depression came first. From a young age, I struggled to gather up the energy and ambition I needed to get out of bed and go to school. I recall my mother having to nearly drag me out of bed even though I had no problems in class. I was a smart, approachable young girl. I could put a bright smile on my face and make friends easily. Regardless of the facts, I felt as though I simply didn’t fit in with others. I had no desire to socialize or do things the other kids did. I was happier alone in my bedroom.
This isolation led me to a place where I began to deeply hate myself. I was slightly overweight and was made fun of for having a big forehead. Insecurity took hold of me and I let it run my life. I learned at the innocent age of 12 that a little Jack Daniels from my parent’s musty liquor cabinet would take away my feelings of insecurity and desolation.
Over the next few years, I began to go to high school intoxicated and alcohol was playing an exhilarating and important part of my life as I sought confidence through a bottle of liquid courage. It was my best friend that later became my worst enemy.
Although alcohol gave me a solution to my depression in the beginning, it eventually made everything worse and substantially changed life as I knew it. By the time I went to college, I couldn’t get out of bed without experiencing alcohol withdrawal. Around this time I was also introduced to opioids – which provided me with the functionality to go to class high until I could get home and take my next drink.
It wasn’t until alcohol and drugs had stolen my desire to live from me that I realized that I had been self-medicating all those years. When I went to a dual diagnosis treatment center I was diagnosed with depression and put on the right medication while receiving therapy to help me get to the root of my problems.
Depression and Alcoholism
The problem with self-medicating through alcohol abuse is that it usually leads to both tolerance and physical dependence towards alcohol. As alcohol is taken in excess over a period of time, the brain undergoes changes which involve judgment and decision making. The pattern of alcohol abuse soon becomes second nature, resulting in alcoholism.
Since alcohol releases feel-good chemicals like dopamine, it causes feelings of euphoria. This can make a person who suffers from depression feel better as it improves their mood and feelings of pleasure. On the other hand, in the case of a person who does not suffer from depression, when the alcohol is removed the brain will experience a lack of dopamine and serotonin. The lack of these chemicals can lead to depression. Left untreated, the vicious cycle of depression and alcoholism can be fatal.
Dual Diagnosis Treatment
Since the prevalence of depression and alcoholism co-occurring is extremely common and dire, it is imperative that both disorders be treated in order to increase the chances of success in sobriety. If only alcohol use disorder is treated, a person with an untreated mental illness is more likely to relapse than those who do not. Dual diagnosis treatment can be beneficial to individuals with co-occurring disorders as it focuses on treating both conditions simultaneously.
When I was in dual diagnosis treatment, I was armed with the relapse prevention tools I needed to both stay sober and treat my depression. I was surrounded by a group of other individuals who were also suffering from mental illness and alcoholism. They not only thoroughly understood what I was going through, but they were willing to listen to me, provide me with immense support, and hold me up when I was down. I learned how healing it can be to openly talk about my problems with other people who shared common experiences.
Treatment also encouraged me to incorporate healthy habits into my daily lifestyle that can also be used as coping mechanisms, such as yoga, meditation, and spending time in nature. These activities are all helpful in reducing stress and anxiety while promoting a sense of well-being.
While the cycle of depression and alcoholism may seem a hopeless one, it is estimated that 20 million people are living in recovery from alcohol abuse. My own recovery proves this as I embarked on a journey of sobriety hand in hand with other alcoholics and addicts. I was given a life where my dreams were restored, my motivation came back with an enthusiastic outlook on life, and I found gratitude for the life I live today. Through treatment, hard work, and a compassionate support group, I believe that anyone has the ability to recover from depression and alcoholism.
Cassidy Webb is an avid writer from South Florida. She advocates spreading awareness on the disease of addiction. Her passion in life is to help others by sharing her experience, strength, and hope.
“You yourself, as much as anybody in the entire universe, deserve your love and affection.” ~Buddha
In 1990, in an early encounter between the Dalai Lama, the foremost Tibetan teacher of Buddhism, and Western students, the Dalia Lama was asked a question about how to deal with self-hatred. He was confused and didn’t understand the question. The translator translated the question again and still the Dalai Lama was confused.
Finally, the Dalai Lama understood that the question was about how to manage negative feelings about the self. This was a new concept to him: he knew that people had negative feelings about others, but he had not encountered the challenge of self-hatred.
I wish I could say that I had never encountered the problem of self-hatred, but I’d be lying. Like so many people, even if I didn’t necessarily recognize my self-talk as such, I was inundated with internal negative self-talk.
My process of coming first to recognize what that voice was up to, then to listen to it with more compassion, and finally, once and for all, to ask it to grow up and step out of the room has been a journey of self acceptance, growth, and ultimately, freedom.
Here are three steps to deal with your own inner negative self-talk:
The first step is to become aware of the negativity of your internal voice.
For the first twenty-eight years of my life, I was so familiar with my negative voice that I didn’t even recognize it.
I’ve been told that people with Tinnitus, a constant ringing sound in the ears, grow used to it and learn to live with it so successfully that they’re no longer really even aware the ringing’s there. That was the case with my negative voice: it was a kind of background hum.
If I did pay attention to it, I was tricked into thinking that its particular message mattered.
At sixteen it might have been the enormous, overly sweet corn muffin I’d eaten on the way home from school that was a sign of my failure.
At twenty-six it might have been that an essay I wrote hadn’t been accepted for publication; this was a sign, I was sure, that nothing I’d ever write would ever be fully understood.
It wasn’t until I’d been in therapy for a while and had a real mindfulness practice that I even began to notice the daily hum of background voices and to notice that the particulars of the negative voice I did hear were less important, actually, than the larger pattern it was a part of.
Any mindfulness practice can help you become more aware of the negative self-talk in your head. You can try guided meditations, deep breathing exercises, or mindful walking, or simply spend time tuning into your senses. When you become conscious of the present moment, it’s easier to recognize what’s going on internally.
The second step is to listen a little more deeply.
What was important was not so much what the voice was saying as what was under the voice. Often the negativity was there to distract me from something else.
Was the corn muffin or the publication rejection really the problem?
The quality of your sleep is affected by everything. From your habits and the food you eat, to the medications you take and drinks you ingest. So, it’s no surprise that if a person has developed an addiction—to an over-the-counter drug, alcohol, or other type of substance—that addiction could affect their sleep quality, too.
Sleep disorders and addiction have a bidirectional relationship: Each individual issue—alcohol dependence, insomnia, etc.—relate to and effect the other issue. The nature of this intricate relationship requires a person seek treatment for both issues to find a healthy, sustainable resolution.
Keep reading to discover how various forms of addiction affect sleep. This guide also will delve into various types of substance-induced sleep disorders, substances that can cause or lead to sleep disorders, and information concerning how an individual can recover from addiction.
The relationship between sleep and addiction
How do various substance addictions upset the body’s brain chemistry and disrupt the natural sleep rhythm? The answers vary. Each substance type has different characteristics, and affects an addicted person’s sleep in various ways.
Cocaine effects the brain’s limbic system. The system consists of interconnected regions that regulate motivation and pleasure. Cocaine’s short-term effects immediately cause a buildup of dopamine, which can cause euphoria. This euphoria can make a person want to take the drug again.
Because cocaine increases wakefulness, it can disrupt REM sleep. And cocaine withdrawal can lead to disturbed sleep and unpleasant dreams (also known as a parasomnia).
Amphetamines stimulate the central nervous system. Although amphetamines are used to treat multiple medical issues, such as depression and attention deficit hyperactivity disorder (ADHD), people can develop a psychological amphetamine dependence.
Use of amphetamines can decrease the amount of time a person spends in REM sleep periods.
Hallucinogens are a group of drugs that can alter a person’s perception, and cause sensations or create images that aren’t real. A few examples of hallucinations are as follows:
D-lysergic acid diethylamide (LSD)
In general, hallucinogens can interfere with serotonin. Serotonin regulates sleep and other major bodily functions. When a person takes a hallucinogen, they can experience short-term sleep problems. A study in the journal Therapeutic Advances in Psychopharmacology also states LSD users often experience a loss of sleep.
Sleep loss, which sometimes presentats as insomnia, can either be chronic (difficulty falling or staying asleep at least three nights a week for three months or more) or short-term (lasts less tan three months, or presents when a person has trouble falling or staying asleep).
MDMA, also known as 3,4-methylenedioxymethamphetamine or ecstasy, is a specific type hallucinogen and stimulant. It’s a synthetic drug. MDMA can make a person feel energized, and distort their perceptions and how they experience time.
People who use a lot of MDMA can experience persistent sleep disturbances. MDMA also can affect the human body’s monoamine neurotransmitters. These neurotransmitters greatly affect sleep and daytime alertness (also known as hypersomnia).
Marijuana dependence is similar to other substance abuse disorders. People who have issues with this substance face social, psychological, and physical impairments. Dependent users also have sleep problems.
A study that appeared in the journal Sleep Medicine Reviews reports that people who smoke marijuana have a hard time falling asleep, and have strange dreams when they experience marijuana withdrawal.
Another study in the journal Addiction Science & Clinical Practice found that chronic cannabis use can negatively affect sleep during withdrawal. Insomnia, sleep withdrawal, and strange dreams were reported.
People often assume alcohol can help them sleep because it causes drowsiness. Although alcohol can help a person fall asleep, it causes disrupted sleep. Disturbances can occur during sleep stage transitions. These disturbances can worsen the effects of insomnia and cause sleep apnea.
The previously mentioned study in the journal Addiction Science & Clinical Practice also reports that alcohol users can experience:
A hard time falling asleep
Awakening during the night
Abnormal sleep quality
Also, insomnia is the most prevalent complaint from alcoholics after they quit drinking.
Opioid drugs come in illegal and legal forms. Heroin, for example, is illegal, and other opioids, such as the synthetic drug fentanyl, and pain relievers, such as oxycodone, hydrocodone, codeine, and morphine, are available via prescription.
All opioids interact with opioid receptors on nerve cells in the body and brain. According to the U.S. government’s National Institute on Drug Abuse, 21 to 29 percent of patients who are prescribed opioids misuse the drugs.
Although most prescription opioids are safe to take for a short period of time, long-term opioid use can cause addiction. Addiction can occur because these pain relieving drugs also can cause euphoria.
The longer a person takes an opioid, the greater the chance they could develop an addiction. Addiction to opioids also can arise from prescription misuse.
Sadly, opioid addiction can lead to death. The CDC searchable database, CDC Wonder, reports that 20,000 overdose deaths in 2016 were related to fentanyl and synthetic opioids.
Why opioids are addictive
Environmental and individual factors impact how a person reacts to opioid drug affects. In general, however, opioids affect a person when the drug enters the bloodstream and travels to the brain.
A study in the journal Science & Practice Perspectives found that proteins that opioids attach to, which are called mu opioid receptors, are located on brain cells. This chemical/receptor interaction triggers the same biochemical brain processes that give people pleasurable feelings via “brain circuits” in the mesolimbic (midbrain) reward system.
According to the article, this “system” creates signals in the brain’s ventral tegmental area (VTA). This “area” releases the chemical dopamine (DA) in another part of the brain, which is referred to as the nucleus accumbens (NAc). Dopamine creates “pleasurable” feelings.
Opioids and sleep
Opioids are a well-known sleep disrupter. A study in the journal Anesthesiology explains that opioids can block the human body’s access to rapid eye movement (REM) sleep. These drugs also can block access to the deeper, restorative stages of non-REM sleep. A lack of sleep can actually make any pain a person may feel—for example, the pain they are taking opioids for—worse.
Opioids, withdrawal and sleep
When a person ceases using opioids, she can experience sleep issues. An article in the journal Psychiatry Research examined the quality of sleep in people who had “heroin use disorder” who were going through “early methadone maintenance therapy” (MMT). The study participants experienced less sleep and daytime sleepiness.
Another study in the journal Drug Alcohol Dependence also found that people in the early stages of methadone detox had issues getting enough sleep. Their sleep quality was poor, too.
When sleep deprivation leads to drug use
Although heavy drug use can lead to sleep issues, sleep issues, such an insomnia, can also lead to drug use.
A study published in the Journal of Youth and Adolescence found that lower levels of weekday sleep were related with substance use, specifically alcohol. An association also was found between alcohol and cigarette use and weekend oversleep, which is defined as “wake time on the weekends as compared to weekdays”. The study also posits that lower sleep times could also lower an individual’s inhibition, and their ability to regulate their emotions, which can lead to substance abuse.
Although the study examined youths’ relationship with the previously mentioned substances, the findings may relate to adults, as the study also discovered that after a follow-up, which occurred two years after the study, alcohol use was associated with weekend sleep delay (defined as a person’s time to bed on the weekends compared to weekdays). Alcohol use also was associated with greater weekend “oversleep”, too.
With young adults myself, this one worries me very, very much.
Teens and young adults who consume cannabis are at an increased risk of depression and suicidal behaviour, suggests a new analysis by a team of researchers at McGill University.
The study follows an awareness campaign by the Quebec government last week that highlighted the risks of smoking pot among young Quebecers. That campaign observed that the brain continues to develop until the age of 25, making teens and young adults more vulnerable to the effects of cannabis.
The McGill study suggests that smoking pot can be linked to depression in about seven per cent of Canadians and Americans between the ages of 18 and 32. That works out to about 25,000 young Canadians and 400,000 young Americans who suffer from depression because of earlier daily or occasional use of cannabis.
The study also warns of a significant increase in the risk of suicidal ideation in teens and young adults who are already susceptible to suicidal behaviour.
The results were published Wednesday in the journal JAMA Psychiatry and are based on a review of nearly a dozen international studies comprising more than 23,000 individuals. The researchers, including colleagues at Oxford University and Rutgers University-Camden, did observe a weaker association between cannabis and anxiety.
A significant percentage of suicidal attempts are attributable to cannabis.”
“When we started this study, we expected depression to be a factor attributable to cannabis consumption, but we were quite surprised about suicide behaviour rates. Indeed, a significant percentage of suicidal attempts are attributable to cannabis,” Dr. Gabriella Gobbi, a psychiatrist at McGill and the lead author of the paper, said in a statement.
In an interview, Gobbi explained that “if you have some risk of suicidal ideation, cannabis increases your risk by 50 per cent.”
“Each person is different. If you have a risk of suicidal behaviour of three per cent, cannabis will increase that risk to maybe 4.5 per cent.”
Gobbi lauded Quebec for launching its awareness campaign.
I am without a doubt the addict of the hopeless variety. I was the guy who would show up to an AA meeting picking up yet another white chip. The guy who everyone thought was such a good guy, but just could never get his life together. The guy you felt bad for and cheered on no matter what. I absolutely hated being that guy, there is something about the addict ego that does not want pity, at least pity from others. Ironically though, I loved to pity myself, it was something that kept me in the throes of addiction for years.
I remember so many times hearing about or seeing someone who was celebrating multiple years of sobriety and I had known them since their first month of sobriety, we had been on the journey together yet I always was the one who veered off while others did the right things and stayed sober. I let my hopelessness define me, which made me indifferent to anything in life for so long. I also believed in the stigma of addiction, that it made me much less than other people.
Indifference is scary, I made so many snap decisions that could of had major impact on the rest of my life without hesitation. My thought process literally was that I didn’t care about myself so who cares what happens. I relapsed so constantly I don’t even know if you could define them as relapses.
One thing I knew at that time was that relapse was quite prominent in those who enter recovery. While I had met the ‘one chip wonders’ before, I knew a lot of people who took quite a few years to fully grasp their recovery and the actions it takes. There was always, no matter how hopeless I was, a little voice in my head telling me, “This isn’t the end, you are on this planet for a greater reason.”
On March 17, 2015 my mom called me and informed me that my father had passed away, I was already at a low with depression and this devastated me. After the service I spent the next two months completely isolated, I didn’t talk to or see anyone for weeks at a time, and crying myself to sleep every night. I was so broken and defeated, just waiting for my life to end. My mom called me around the middle of May that year and asked if I wanted help, I said yes of course, but had very little hope of being able to gain any kind of productive life back.
Being in an institution was what I needed, I needed somewhere I was being watched over and where I not only felt safe, but felt I at least had a chance at life. A big problem I usually suffered from was that I thought I knew what was best for me, always. The writing was on the wall that I did not know what was best for me, it took a lot of pain and suffering to see that. I won’t necessarily talk about what it was that I had personally had to do , I just want to reiterate how important it was that I was ready to listen to someone else’s ideas on what I should do about my addiction and depression. Someone who had my best interest in mind, usually someone who had been what I had been through and gotten out of it. With the attitude of being teachable, and opening up to people I trusted, truly opened up, I began to notice a change and experience some genuine fulfillment. May 17,2015 was the first day I decided to do this, I have been sober ever since.
That is not to say life has been easy, I still experience periods of time where I am down on myself and feel like I am moving backwards, the most important thing I do about it is tell somebody. There is something about opening up how I really feel to someone that really gets me into gear to do something about whatever is setting me back. Isolation is my absolute worst enemy, I get a sick twisted kind of comfort from it but it produces nothing positive. Please, if you need help, you must ask for it yourself. Find someone you trust and let them know how much pain you are truly in, it’s the first step we all must take in order to get on that path to being happy. My life is better than it ever has been and I owe it to everyone who supports me as much as I owe it to myself.
Creating While Clean
Steven Tyler, Julien Baker, Ben Harper, Jason Isbell, Joe Walsh, and other sober musicians on how to thrive creatively without drugs or booze.
This is a story about sober musicians—about the life that has led them here, and about the life that they live now—but there is no single story here.
Some drank, some used drugs, some did more or less everything, and they did so to very different degrees. Some found themselves at the edge of the precipice, or worse; others simply re-routed from a path or trajectory that they came to see as unwise. Some were clean before the end of their teenage years; some only surfaced into sobriety much later in their lives. Some created the work that made them ﬁrst or best known before they were sober; some have done so since. Some see signiﬁcant correlations here; some don’t.
In the modern pop-culture tradition, being a musician has often come with a series of default lifestyle expectations, ones of indulgence and recklessness, larger-than-life living, and a diligent pursuit of altered forms of consciousness. Some see these expectations as having played a part in what happened to them, though most ultimately see their decisions and actions as also—if not mainly—a matter of their own psychology and personality and predisposition.
Some delight in a dark humor about their earlier excesses; others talk in a way that suggests that to dwell on these too much, to give such memories too much oxygen, would be to take too lightly something they simply can’t risk taking lightly. That it would be foolhardy or perilous to risk returning, even in thought, to a place where for all kinds of reasons they’d rather not linger. A corollary is that some are reluctant in this context to offer much detail about the particular substances that they consumed, or that consumed them, or both. (Readers may be aware that at other times, in different situations or at different stages of their recovery, some of these interviewees may have detailed further speciﬁcs about how they used to alter their body chemistry, but GQ is respecting what they have chosen to share in this particular circumstance and setting.)
Some hew closely to the language of recovery programs; some don’t. (Readers may also notice that some in the former category prefer to honor rigorously the “…anonymous” code of such programs by not even specifying them.) Some have relapsed along the way; some have not—but to varying extents they all remain aware and watchful of the possibility. Some clearly think that everyone would be better in the long run to live the way they currently live; others consider where they are now a personal solution for their own individual predicament that should not necessarily be prescriptive for others.
What they have in common is that they are all, by their own account, for now, living sober. And quite evidently they all strongly believe—whatever their varying reasons and circumstances and perspectives and challenges—that sobriety has made life better.
From the New York Times.
THE OPIOID EPIDEMIC is devastating America. Overdoses have passed car crashes and gun violence to become the leading cause of death for Americans under 55. The epidemic has killed more people than H.I.V. at the peak of that disease, and its death toll exceeds those of the wars in Vietnam and Iraq combined. Funerals for young people have become common. Every 11 minutes, another life is lost.
So why do so many people start using these drugs? Why don’t they stop?
Some people are more susceptible to addiction than others. But nobody is immune. For many, opioids like heroin entice by bestowing an immediate sense of tranquility, only to trap the user in a vicious cycle that essentially rewires the brain.
Getting hooked is nobody’s plan. Some turn to heroin because prescription painkillers are tough to get. Fentanyl, which is 50 times more potent than heroin, has snaked its way into other drugs like cocaine, Xanax and MDMA, widening the epidemic.
To understand what goes through the minds and bodies of opioid users, The New York Times spent months interviewing users, family members and addiction experts. Using their insights, we created a visual representation of how the strong lure of these powerful drugs can hijack the brain.
Dr. Pedro Mateu-Gelabert, one of the nation’s top opioid researchers, said this work brings “an emotional understanding” to the epidemic but “without glamorizing or oversimplifying.”