No Two Addictions are the Same

By David B. Bohl
Originally published on his website, David B. Bohl, on February 4, 2019 – with links to AA Agnostica

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.”

Read more here…

Alcohol Awareness Month: Depression, Alcoholism, and Recovery

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.

My Story

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.

Recovery

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.

How Addiction Affects Sleep

From The Sleep Help Institute

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.

Stimulants
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
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:

Ayahuasca
DMT
D-lysergic acid diethylamide (LSD)
Peyote (Mescaline)
4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin)
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).

Depressants
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
Daytime sleepiness
Abnormal sleep quality
Also, insomnia is the most prevalent complaint from alcoholics after they quit drinking.

Opioids

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.

Read more here.

Ingrained with hopelessness

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.

Summoning happiness to aid recovery

From Harvard

 

Positive psychology exercises boost moods of those struggling with addiction says MGH study

Short writing exercises reliving happy moments boosted the moods of adults recovering from addiction in a study conducted by researchers at Massachusetts General Hospital’s (MGH) Recovery Research Institute.

“Recovery is hard,” said lead author Bettina B. Hoeppner, senior research scientist at the institute and an associate professor of psychology at Harvard Medical School. “For the effort to be sustainable, positive experiences need to be attainable along the way.”

More than 500 people struggling with addiction participated in the randomized, online survey. They each were assigned one of five psychology exercises that took an average of four minutes to complete.

Participants reported the greatest mood lift after completing an exercise that had them select and describe one of their own photos capturing a happy time. An exercise in which participants noted two positive experiences from the previous day led to the next-highest gains in happiness, followed by one that had them list a highlight and a challenge from the day before and a pleasure anticipated the next day. Those who were asked to write only about challenges they had faced the previous day saw a dip in happiness.

The study’s authors say exercises such as the ones used in their study hold promise as a tool for promoting happiness during treatment, which may help support long-term recovery.

“Addiction scientists are increasingly moving beyond the traditional focus on reducing or eliminating substance use by advocating treatment protocols that encompass quality of life,” Hoeppner said. “Yet orchestrated positive experiences are rarely incorporated into treatment.”

9 musicians on How They Thrive Creatively Without Drugs or Booze

From GQ

 

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.

Read more here.

My family has a history of alcoholism. Here’s how I’m teaching my son to fight back.

From The Washington Post

October 10 at 9:00 AM

On a particularly sticky, Florida summer day, I watched as my son, then 8 years old, glided on his scooter up and down the ramps of the skate park. Occasionally he’d stop and observe the other kids sail across the pavement, flipping the base of their scooters around as they ascended higher than the confines of the park’s ramps.

My son, watching one boy in particular, asked me to find out how he was able to kick off the steepest ramps with such ease. My son wanted to do the same, but he was scared.

“I think you should ask him,” I said. My son, whose fear of asking and being rejected was stronger than his yearning to scale the tallest ramp at the skatepark, scoffed, folded his arms and stomped away. He circled the other child on his scooter, watching and calculating. Then he came back and pleaded with me to ask the other boy to help him. I said no and maintained that he should be asking if he was the one who wanted the help. He stayed angry with me, scowling in my direction from time to time.

Read more here…

How alcohol negatively impacts sleep

Alcohol and Sleep

Article by Tuck.

Alcohol causes drowsiness. This has led to the popular misconception that it can aid sleep. Up to 20 percent of Americans report using alcohol as a sleep aid. However, alcohol negatively impacts the quality of your sleep, as well as how long you can expect to sleep. Alcohol consumption before bed causes interrupted sleep, due to side effects such as night sweats and disturbed REM sleep.

Alcohol dependence and sleep disorders are often co-morbid – people suffer both at the same time. Alcohol-related sleep disorders include insomnia, sleep apnea, and daytime fatigue.

The problem with using alcohol as a sleep aid

Alcohol does reduce the initial amount of time required for you to fall asleep. However, it result in disrupted sleep.

The problem with using one drink as a sleep aid, is that while it may work initially, eventually your body develops a tolerance for it. As a result, you may find yourself needing more and more levels of alcohol in order to fall asleep, which can lead to alcoholism. Using alcohol as a sleep aid is dangerous as it can lead to dependence and even alcoholism.

One drink before bed may not impact sleep quality or length. However, the effects of alcohol on sleep are directly correlated – the more alcohol that is consumed, the worse the effects on sleep.

Read more here…

The Problem That Comes After Your Drinking Problem

It was only after I walked away from alcohol that people thought I needed help

I finally stopped using the addictive, carcinogenic drug ethanol, known by its street name alcohol, three months ago.

I’m not counting the days anymore. Not really. Because that would be the same as counting the days of the rest of my life. But still, I know it’s been three months, and I’m ready to start talking about it.

I don’t expect a congratulations, at least not from people who still drink regularly. When I was drinking I wouldn’t have congratulated you, either.

I expect something more like crickets. Crickets, plus awkward silence. Awkward silence, followed by awkward questions, questions like:

Why in the world would you do that?

Surely, you’re not one of them?

Not, you know, an alcoholic?

Well, no, I don’t think so. In truth, I don’t find that word particularly useful, and as such, I don’t identify with it. The term “alcoholic” places the problem within the person, not within the nature of the drug. Thinking that I was the problem is what kept me stuck, hooked on alcohol, long after I wanted to be free.

Depression in Recovery: Do You Have Low Dopamine Tone?

By Amy Dresner 09/10/18 – for The Fix

I just felt like shit and slept as much as I could. I showed up to work. I kept my commitments. I spoke when asked to, but I felt more than unhappy. I felt like I just didn’t care.

(The Fix does not provide medical advice, diagnosis, or treatment, nor does anything on this website create a physician/patient relationship.  If you require medical advice, diagnosis, or treatment, please consult your physician.)

I just came out of a six-week depression. That might not sound very long, but when you’re in hell it feels like forever. Good news: I didn’t bone any 25-year-old strangers; I didn’t cut myself; I didn’t get loaded; I didn’t smoke or vape although I really, really wanted to. I didn’t even eat pints of Ben and Jerry’s while binge-watching I Am A Killer. I just felt like shit and slept as much as I could. I showed up to work. I kept my commitments. I spoke when asked to, but I felt more than unhappy. I felt like I just didn’t care. I didn’t return phone calls. I didn’t wash my hair. Suicidal thoughts bounced around my head, but I ignored them like I do those annoying dudes with clipboards outside Whole Foods.