My son (daughter, mother, father, wife, husband, friend, employee, boss, neighbor) is addicted. What should I do?
It can be very perplexing to those who do not suffer from an addiction, watching someone struggle and damage their life in myriad ways. Why do they do it? Why don’t they stop? The person who is addicted is frequently equally perplexed: “How is it possible that I would disappoint my parents and siblings? How can I ignore and deprive my children and loved ones, the very people I have chosen to share my life with?”
“How can I value my addiction above everything I have always cared for and thought was important? The reason this behavior is incomprehensible is because most of us don’t understand how the brain works and so we ask the wrong questions. One of the right questions is “What has happened to the brain of a person who is suffering from addiction that causes their decision making processes to be compromised?”
Your judgement is usually not helpful, but your understanding always is.
“How is it possible to have compassion for someone whom you believe is choosing to live a life of drug addiction? Someone who chooses drugs over their families, over their children, over their job?
As we explored with Dr. Drew previously in the #14Days on the Wagon series, stigma surrounding addiction is often tied into the widespread belief that addiction is a choice or a moral failing. Experts say this is a misunderstanding of addiction.”
The Study from the NDRI (National Developement and Research Institutes, Inc.
“Many college students participating in Collegiate Recovery Programs (CRPs) for drug and alcohol addictions also report being in recovery from or currently engaging in multiple behavioral addictions, a new survey finds. These addictions include eating disorders, and sex and love addiction.”
Site Administrator: The truth is that addictions do not develop because people make poor choices. Almost everyone in this society indulges in potentially addictive behaviors such as smoking, drinking, gambling, overeating, using illicit drugs, etc. The problem is that, because of preexisting brain conditions which are brought about by genetic makeup and traumatic life histories, some people who indulge in those behaviors will have an almost overwhelming desire to repeat addictive behaviors and will very quickly develop dependencies. Until people understand they have potential vulnerabilities to many addictive behaviors or substances, they will be at risk. Once they do understand that about themselves, they then have the opportunity to make poor choices . . . . or good ones.
Initial use of a drug (including the drugs alcohol and tobacco) or engaging in a potentially addictive behavior is a choice, but when we criminalize that choice we make criminals out of the great majority of our population. People who are predisposed to addiction are a subset of that group. They make the same choice almost all of us make: to try a drug. The fact that they have a predisposition to addiction is NOT a choice.
Excerpts from an article in the NY Times by Maia Szalavitz:
The positive side of wanting is feeling empowered and focused on getting what you desire; the negative side, of course, is craving that goes unsatiated.
The second kind of pleasure, which Dr. Berridge calls “liking,” is linked with the satisfaction and comfort of having achieved your goal. While there is less downside here, if people felt forever satisfied, they’d probably lack motivation to do much. The psychiatrist Donald Klein eloquently distinguished the two joys as the “pleasures of the hunt” and the “pleasures of the feast.”
Dr. Berridge and his colleagues showed how wanting and liking rely on distinct but connected circuitry. In his theory of addiction, he argues that wanting escalates as drug use increases, while liking plateaus or diminishes, leaving people frantically seeking something that no longer provides much, if any, satisfaction.
“Millions of years of evolution have told you that at some point food is the most important thing and at some point it’s not,” said Dr. Seeley, explaining how the brain makes choices about whether food or something else, like sex, should be desirable at any given time. He added, “It’s not a system that was designed to just accede to your force of will.”
This is why willpower alone is not an adequate tool to end an addiction to alcohol or anything else.
Dr. Nora Volkow, the director of the National Institute on Drug Abuse, is funding research on these medications for drug addictions. She said that they might work “by interfering with that urge to have more.” It will be fascinating to learn whether it’s possible to alter or even create a set point that signals that “enough” drugs have been taken. People with alcohol problems seem to lack such an off switch, while those who drink moderately report clearly knowing when to stop.
Seeing people change with ease on medication after years of struggle could help the public recognize that these are truly medical issues. Simply by working the way they do, GLP-1 medications suggest that the difference between addicted people and others is chemistry, not choices.
It is long past time to stop shaming people with disorders of appetite in a futile attempt to tame our own fears of loss of control. Whatever condition is being treated, we all deserve the easiest possible path to recovery. Understanding how wanting, liking and attention are regulated by the brain could lead to better self-control for many, across diagnoses.
When we judge, we place ourselves above those we judge
When we engage with compassion, we are with them
Real change comes from compassion, not judgement
From The New York Times:
“We must get over this idea that punitive measures are the answer to addiction. Too long have we taken the attitude that addiction is a matter of choice — or, even if it isn’t, “those people” chose to use drugs, so society shouldn’t have to deal with it. Let them suffer the effects of their own mistakes. (Subtext: they sinned; God is punishing them.)
Well, God is punishing us all. Addiction (including alcoholism) costs the US hundreds of billions of dollars a year, when you consider the medical costs, the lost productivity, the cost to businesses, the cost of law enforcement, the cost of incarceration, the cost of the ridiculous “War on Drugs, and the cost to families, friends, neighborhoods, reduced property value and the myriad other issues surrounding drug and alcohol use.”
For those of you addicted to judging , who separate yourself from those who are addicted, please go to this webpage, which basically confirms that, “there, but for the grace of god, go I” or, more accurately, “There but for the grace of God, goes John Bradford”
And now, back to the CBS News story
According to the National Institute on Drug Abuse, addiction is defined as a “chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her.” The physical brain changes that occur over time impair an addicted person’s self control and hamper his or her ability to resist intense impulses to take drugs.
We tend to think of our bodies as if they were ships piloted by a captain: The captain says “Come about from port to starboard” and the ship changes direction. As David Eagleman, a neuroscientist, points out in his fine book “Incognito”, our brains do not have just one captain. Our brains have many captains who fight to have their voices heard by the crew, and these captains have different agendas and different values and use different metrics to determine the success of those actions.
David Eagleman, again, but from a different book: “This Explains Everything”, is quoted by John Brockman (p. 91):
“The deep and beautiful trick of the brain is more interesting: It possesses multiple, overlapping ways of dealing with the world. It is a machine built of conflicting parts. It is a representative democracy that functions by competitions, among parties who all believe they know the right way to solve the problem.
As a result, we can get mad at ourselves, argue with ourselves, curse at ourselves, and contract with ourselves. We can feel conflicted. These sorts of neural battles lie behind marital infidelity, relapses into addiction, cheating on diets, breaking of New Year’s resolutions—all situations in which some parts of a person want one thing and other parts another.”
“Consider the different systems involved in decision making: Some are fast, automatic, and below the surface of conscious awareness; others are slow, cognitive, and conscious. And there’s no reason to assume that there are only two systems; there may well be a spectrum. Some networks in the brain are implicated in long-term decisions, others in short-term impulses—and there may be a fleet of medium-term biases as well.”
Unfortunately, our brains have evolved to value short term rewards over long term satisfaction and as addiction takes hold of the brain these decisions are made more and more at an unconscious level.
Human Disorder by Thomas Overloop
To quote from his book Incognito (pp. 204-205):
“Consider the powerful effects of the small molecules we call narcotics. The molecules alter consciousness, affect cognition, and navigate behavior. We are slave to these molecules. Tobacco, alcohol, and cocaine are self-administered universally for the purpose of mood changing. If we knew nothing else about neurobiology, the mere existence of narcotics would give us all the evidence we require that our behavior and psychology can be commandeered at the molecular level. Take cocaine as an example. This drug interacts with a specific network in the brain, one that registers rewarding events—anything from slaking your thirst with a cool iced tea, to winning a smile from the right person, to cracking a tough problem, to hearing “Good job!” By tying positive outcomes to the behaviors that led to them, this widespread neural circuit (known as the mesolimbic dopamine system) learns how to optimize behavior in the world. It aids us in getting food, drink, and mates, and it helps us navigate life’s daily decisions.
Out of context, cocaine is a totally uninteresting molecule: seventeen carbon atoms, twenty-one hydrogens, one nitrogen, and four oxygens. What makes cocaine cocaine is the fact that its accidental shape happens to fit lock-and-key into the microscopic machinery of the reward circuits. The same goes for all four major classes of drugs of abuse: alcohol, nicotine, psychostimulants (such as amphetamines), and opiates (such as morphine): by one inroad or another, they all plug into this reward circuitry. Substances that can give a shot in the arm to the mesolimbic dopamine system have self-reinforcing effects, and users will rob stores and mug elderly people to continue obtaining these specific molecular shapes. These chemicals, working their magic at scales one thousand times smaller than the width of a human hair, make the users feel invincible and euphoric. By plugging into the dopamine system, Cocaine and its cousins commandeer the reward system, telling the brain that this is the best possible thing that could be happening. The ancient circuits are hijacked.”
For those not addicted to drugs, the addicted become “Them”. They are incomprehensible and alien. The truth, however, is that everyone is addicted. Our brains have evolved so that the reward system governs our behavior. Just as an addict uses a drug, a person satisfies his hunger by eating, her thirst by drinking, and desire with sexual behavior. We do not normally think about eating or drinking, we just eat when we are hungry and drink when we are thirsty. And just like eating or drinking or sex, we can exert control over ourselves, but it takes work, effort and mediation. A person dying of thirst can still stop themselves from drinking poisoned water, but it’s not easy. When non-addicts think about addicts, they are thinking about people who have added a few maladaptive drives and feedback loops to their reward centers, not about people who are irresponsible, evil or weak.
How could we have allowed ourselves to become addicted?
The mystery is, how could you have not?
This is not about “them”. This is about us. Very few of us feel like we are OK. Very few of us feel complete. People whom we envy from the outside struggle also, and many people whom we admire feel as if they are not good enough. Watch the story of Marin Riggs, please.
Study Finds that Some Brains are Wired for Addiction
Posted on February 2, 2012 by The BBC:
Scientists have long wondered why some people become addicted to drugs and alcohol while others can resist the pull of addiction. Now a new study of siblings suggests that certain brains are wired for addiction. Researchers at Cambridge University in the U.K. compared brain scans of 50 addicts to those of a non-addicted brother or sister. The results of the study, which are published this month in Science, indicate that the brains of each sibling pair were similar in many areas and that both brains were unlike those of typical people who have no history of substance abuse.
For background, see this article from the BBC “Brains may be wired for addiction”
The addicted test subjects in the study had long histories of drug abuse. Most had been using cocaine or methamphetamine for an average of 16 years. More than half were also addicted to prescription painkillers or heroin and about a quarter were alcoholic. In addition to the sibling pairs, the study involved 50 unrelated healthy people with no history of substance abuse who were used as control subjects.
Using a standard test for impulse control, researchers found that both the addicts and their non-addicted siblings tested poorly for impulse control when compared to the unrelated control group. Brain scans that were also conducted as part of the study found similar abnormalities in the area of the brain that’s involved with self-control in the pairs of siblings. These results suggest that poor impulse control is an inborn characteristic of some brains and that it appears to be inherited.
Scientists have previously observed differences in the brain structure of addicts but were unsure if the differences were the cause or result of substance abuse. By adding siblings as test subjects, this new study indicates that differences in brain structure are an apparent cause of drug abuse.
One of the questions that remains unanswered is why one person becomes addicted to drugs when their sibling who has a similar brain structure is able to stay drug-free. According to Karen Ersche, the lead author of the study, the research team plans on doing more tests with sibling pairs in order to answer this question.
Nora Volkow, director of the U.S. National Institute on Drug Abuse, commented on the result of the study in an interview on NPR. Volkow says the implications about poor impulse control go beyond the problem of drug addiction. Impulse control is one of the central issues in ADHD (attention deficit hyperactivity disorder). It also is a key element in compulsive disorders like gambling and compulsive eating. If people who are susceptible to these disorders can be identified by their brain structure and family history, there is the possibility for helping them strengthen their self control before they develop serious problems.
Tales of Neurotransmitters
There are people who take pride in their ability to hold their alcohol and one of the stigmas that goes along with an addiction to alcohol is not being able to “hold your liquor”. How strange is that? Alcohol is a drug, pure and simple. We don’t really talk about people not being able to “hold their heroin” or “hold their crack” or “hold their meth”. Anybody who said such a stupid thing would be laughed out of the room. Different people will easily become enslaved to different drugs. For one person, alcohol is their kryptonite. A person whose glucocorticoid system (fight or flight) is stuck on overdrive, either because of genetic disposition or PTSD/trauma, will be attracted to substances or behaviors which will calm them, like alcohol or benzos or heroin. A person whose dopamine system underperforms will find it hard to get excited about anything or to be motivated to get out of the damn bed, and will be attracted to substances or activities which excite him or her, like coke or meth or gambling. A person tries something and it may just feel good, but if that something “changes everything” then they will have the feeling they have discovered the love of their life and that person has also found their kryptonite. I gave up coke and it was no problem. It took me well over a decade to give up heroin. When we see someone getting trapped in a repetitive, dysfunctional, harmful behavior we may be unable to understand them or their behavior. That’s because their “repetitive, dysfunctional, harmful behavior” is that person’s kryptonite, but not ours. I would urge people not to judge because for most of us, our doomsday behavior or substance is out there waiting for us.
This Ted x talk by David Hendricks presents a possible explanation for how some of our brains can become “wired” for addiction and also how those same brains can be rewired for recovery:
Addictive Personality? You Might be a Leader
By DAVID J. LINDEN
Published: July 23, 2011
David J. Linden is a professor of neuroscience at Johns Hopkins University School of Medicine and the author of “The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good.”
Rethinking Addiction’s Roots, and Its Treatment (July 11, 2011)
WHEN we think of the qualities we seek in visionary leaders, we think of intelligence, creativity, wisdom and charisma, but also the drive to succeed, a hunger for innovation, a willingness to challenge established ideas and practices.
But in fact, the psychological profile of a compelling leader — think of tech pioneers like Jeff Bezos, Larry Ellison and Steven P. Jobs — is also that of the compulsive risk-taker, someone with a high degree of novelty-seeking behavior. In short, what we seek in leaders is often the same kind of personality type that is found in addicts, whether they are dependent on gambling, alcohol, sex or drugs.
How can this be? We typically see addicts as weak-willed losers, and chief executives and entrepreneurs are people with discipline and fortitude. To understand this apparent contradiction we need to look under the hood of the brain, and in particular at the functions that relate to pleasure and reward.
As a key motivator, pleasure is central to learning; if we did not find food, water and sex rewarding we would not survive and have children. Pleasure evokes neural signals that converge on a small group of interconnected brain areas called the medial forebrain pleasure circuit — tiny clumps of neurons in which the neurotransmitter dopamine plays a crucial role.
This dopamine-using pleasure circuitry, refined over millenniums of evolution, can also be artificially activated by some, but not all, psychoactive substances that carry a risk for addiction, like cocaine, heroin, nicotine or alcohol. Our brain’s pleasure circuits are also hard-wired to be activated by unpredictable rewards: While a roulette wheel is spinning or horses are on the track, we get a pleasure buzz even if we don’t get a payout in the end. Uncertainty itself can be rewarding — clearly a useful attribute for high-risk, high-reward business ventures.
So why do some people become addicted to drugs, alcohol, gambling or sex while others can indulge in a moderate, non-compulsive manner? One hypothesis is that addicts feel those pleasures unusually strongly and are motivated to seek them more intently. It’s reasonable, but wrong. Evidence from animal experiments and human brain scans indicates that the opposite is true: Addicts want their pleasures more but like them less.
We’re now starting to understand the biology behind the blunted pleasure of addicts. From studies comparing identical and fraternal twins, it is estimated that genetic factors account for 40 to 60 percent of the variation in the risk for addiction. But we are only in the early stages of understanding the role of genes in addiction; there is no one “addiction gene,” but it is likely that a large number of genes are involved in this complex trait.
Site Administrator: The same is true of people who have a personal history of traumatic experiences, which seems to produce the same affects as genetic variance. For a long time, the exact mechanisms of addiction susceptibility were a mystery, but scientific research is starting to come up with likely answers. Genetic variance occurs in the formation of the dopamine, oxytocin and glucocorticoid neurotransmitter systems (and possibly the Serotonin and Endorphin neurotransmitter systems also). It was found that some of those who experienced trauma before the age of five (and sometimes later in life) experienced damage and/or disruption to those systems. One of the side effects of dysfunction the the oxytocin system is difficulty in forming attachments and love relationship problems.
To get a clear understanding how these systems are affected please read this excellent study from the National Center for Biotechnology Information. There is even discussion of using oxytocin as a medication to help with curing addiction.
One thing which has become clear only recently is that dopamine is not really the pleasure neurotransmitter, but it does create a desire to repeat pleasurable behaviors. This was verified when scientists performed an experiment on rats. They taught the rats to press a lever in order to get sugar water. When the rats received the sweet water, they typically showed a “rat smile” (they would open their mouths and stick their tongues out and wiggle them). They then gave the rats a chemical which destroyed all of their dopamine receptors so they could no longer experience the affects of dopamine. They put the rats back in the cage which contained the lever but the rats would no longer depress the lever. They just sat there. To test whether the rats were not experiencing pleasure or not experiencing desire, they took a dropper and dropped the sugar water into the rats mouths. Voila! The rats “smiled”. They just had no desire to get the water, even though they still enjoyed it.
Crucially, genetic variants that suppress dopamine signaling in the pleasure circuit substantially increase pleasure- and novelty-seeking behaviors — their bearers must seek high levels of stimulation to reach the same level of pleasure that others can achieve with more moderate indulgence. Those blunted dopamine receptor variants are associated with substantially increased risk of addiction to a range of substances and behaviors.
Is there a silver lining to the addictive personality? Some of our most revered historical figures were addicts — not only the obvious creative types like Charles Baudelaire (hashish and opium) and Aldous Huxley (alcohol and the nonaddictive hallucinogens mescaline and LSD), but also scientists like Sigmund Freud (cocaine) and warriors and statesmen from Alexander the Great and Winston Churchill (both known to be heavy drinkers) to Otto von Bismarck, the unifier of Germany, who typically drank two bottles of wine with lunch and topped them off with a little morphine in the evening.
Leaders in America rarely admit to addictions in public, but one recent example is Henry T. Nicholas III, a founder of Broadcom, a multibillion-dollar company that makes microchips for cellphones, game consoles, wireless headsets and other electronic devices. Starting with a $10,000 investment, Mr. Nicholas and his partners created a company that now has 9,000 employees and 5,100 patents. Along the way, he struggled with alcohol, cocaine and Ecstasy; he entered a rehab program in 2008. (He also successfully fought off criminal charges related to backdating stock options and drug distribution.)
The risk-taking, novelty-seeking and obsessive personality traits often found in addicts can be harnessed to make them very effective in the workplace. For many leaders, it’s not the case that they succeed in spite of their addiction; rather, the same brain wiring and chemistry that make them addicts also confer on them behavioral traits that serve them well.
So, when searching for your organization’s next leader, look for someone with an attenuated dopamine function: someone who is never satisfied with the status quo, someone who wants the feeling of success more than others — but likes it less.
Genetic links? Yup!
The Roosevelts and Alcoholism
Elliott Roosevelt (brother of Teddy Roosevelt) : Elliott Bulloch Roosevelt (1860-1894), nicknamed “Ellie” or “Nell,” was the third child of Theodore Roosevelt, Sr., and Martha (Mittie) Bulloch Roosevelt. He was also the father of First Lady Anna Eleanor Roosevelt and the younger brother of President Theodore Roosevelt.
Born two years after his more famous brother Theodore, Elliott shared a competitive relationship with Theodore. Elliott was often considered the more successful of the brothers when they were younger, only to be surpassed by his brother later in life. Elliott’s lifelong struggle with alcoholism would lead to his estrangement from his family when the children were quite young.
Elliott’s illnesses resurfaced shortly after his return to New York in March 1882. At the age of eighteen he had begun to use alcohol as a depressant hoping to stem his attacks. By 1882 his excessive consumption of alcohol was becoming a major concern to the family as would his later use of Laudanum and morphine.7
On August 14, 1894, at the age of 34, Elliott attempted suicide by jumping out a window; he survived the initial fall, but suffered a seizure and died a few days later. At the time of his death, his alcoholism had escalated such that he was consuming numerous bottles of Champagne and brandy each day.
Elliott Roosevelt was truly a pathetic figure who, despite his wealth and privilege, suffered like millions of his fellow alcoholics from an ancient disease that was publicly regarded not as a disease at all but rather as a shameful mark of moral degeneracy.
Kermit Roosevelt (son of Teddy Roosevelt): Kermit Roosevelt(1889-1943) was the precocious second son of Theodore and Edith Kermit Carow Roosevelt. Kermit shared his father’s wit, mastery of language, and passion for outdoor activities and exploration. Unlike his father, however, Kermit was easily depressed. Like his Uncle Elliott before him, Kermit was afflicted with a tendency to drink excessively. Adding to the parents’ concern was the knowledge that Edith’s father had also been an alcoholic. Following Kermit’s return to the United States, Archie Roosevelt encouraged his brother to seek treatment for his alcoholism. Belle and Archie, believing military service would help ensure Kermit’s sobriety, lobbied FDR to find a place for Kermit. After refusing a stateside post as an
information officer, Major Kermit Roosevelt accepted an assignment to Fort Richardson, Alaska, where he helped organize a territorial militia to fight Japanese forces in the Aleutian Islands. Unable to control his drinking, Kermit was medically discharged in early 1943. After learning that Kermit was traveling the country with his mistress, Belle requested that he be returned to active duty at once. By May Kermit was back at Fort Richardson. Physically unfit for duty, a despondent Kermit committed suicide at Fort Richardson on June 4, 1943.
Gracie Hall Roosevelt (son of Elliott Roosevelt): Gracie Hall Roosevelt (June 28, 1891 – September 25, 1941) was the youngest brother of First Lady of the United States Eleanor Roosevelt and a nephew of President Theodore Roosevelt. He was usually called Hall. When Hall was one year old, his mother, Anna Hall Roosevelt, died, and shortly after his third birthday his father, Elliott Roosevelt, died as well. He and Eleanor were then reared by their grandmother at her estate in Tivoli, New York.
Gracie Hall Roosevelt (1891-1941) attended Groton, was elected to Phi Beta Kappa in college, and received a master’s degree in engineering from Harvard. Like his father Elliott he was brilliant, charming, and drank and partied too much. At the age of twenty-one Gracie married Margaret Richardson (1892-1941) with whom he fathered three children prior to their divorce in 1925. He subsequently married Dorothy Kemp (1898-1985) and had three additional children before they divorced in 1937. Gracie was initially employed in the railroad industry and later as the controller of the City of Detroit. An alcoholic by 1937, Gracie’s consumption of alcohol had increased to the point that he was unable to work and spent the last years of his life residing in a small cottage on President Franklin Delano Roosevelt’s Hyde Park, New York, estate which was located just twenty miles from Hall’s Oak Terrace estate where Gracie had been raised.
Eleanor Roosevelt (Teddy Roosevelt’s niece, Elliott Roosevelt’s daughter and Franklin Roosevelt’s wife): Anna Eleanor Roosevelt was born October 11, 1884, the first of three children of Anna Livingston Hall and Elliott Roosevelt. Her childhood was complicated, painful, and demanding. Her younger brother Elliott died in infancy. Her father, whose brother was President Theodore Roosevelt, battled addictions to alcohol and morphine and her mother, tormented by her husband’s behavior, often emphasized what she saw as young Eleanor’s shortcomings. Both parents would die before ER’s eleventh birthday. Mary Livingston Hall, ER’s maternal grandmother, took ER and her younger brother Hall into her Tivoli, New York home, where they also confronted alcoholism and intense sadness.
Eleanor Roosevelt, Niece of Eleanor Roosevelt: My aunt Eleanor had a distinct aversion to alcohol because it had affected so many people in her family. Her father had died of alcoholism. Her brother Hall, my father, would die of alcoholism.
From Ken Burns’ The Roosevelts: An Intimate History:
Discussing Hall Roosevelt, whom Eleanor had taken care of when they were children after their father and mother had died: “He had been bright and promising when young, filled with all the Roosevelt energy, and had become an able engineer and city official, but the curse of alcoholism that had killed his father destroyed him too.
“My idea of Hell, if I believed in it,” Eleanor confided to her friend, Joe Lash before the end came (That is, before Hall died), “would be to sit and watch someone breathing hard, struggling for words when a gleam of consciousness returns, and thinking this was once the little boy I played with and scolded. He could have been so much, and this is what he is.”
Site Administrator: And so it goes, like a terrible plague, through families. For those of you for whom addiction is not a problem, never look down on anybody unless you are helping them up.
So, the question is not “Why does a person who is addicted to a substance or behavior engage in self-destruction and disappoint and harm others?” That question can be usefully asked of all of us, for we all make bad decisions based upon short term desires which we value over our long term interests. The useful question to ask is “Now that this person’s brain has been rewired and his behavior has become problematic, what needs to be done to break the cycle of addiction and change their behavior?”
The questions we ask determine the answers we will get.
But wait, you may say. We all have brains which work this way. Why do we not all develop debilitating addictions? While it’s true we all have brains which are shaped by rewards and which receive a pleasurable charge when we ingest certain drugs, and we all have brains which value short term benefits over long term interests, we are not all exactly alike. Scientists have been making great strides in understanding why some people fall prey to addiction while others are able to see they are headed for trouble and choose to not continue down that road. How do scientists parse what are the contributing factors which lead to addiction? How do they look at a person who suffers from a debilitating addiction and determine what led to that state of affairs? Scientists use statistics. At this time no one knows how to look at one individual and determine why they are more addiction prone than others or to look at an individual and determine what characteristics they possess which have led to their addiction. Scientists do, however, know how to look at a large population of people and determine the qualities which one group may share that make them different from other members of the population. But let’s be clear: what we are talking about here are tendencies, not deterministic factors. One major tool scientists use is twin studies: twins have more genetic material in common than other members of the population and make a very good study group. To understand what qualities are due to heredity, rather than environment, they study twins who were separated at birth and raised by different families. If one twin developed an addiction, they found the other twin had a much higher chance of developing an addiction than the general population. What they found out was that approximately 40%-60% of all the causes of addiction are due to the genes we inherit. For further information on genetic influences, see here, here, and here. The main mechanism at work here is underperforming or out of balance neurotransmitter systems (see Frederick Von Stieff’s “Brain in Balance“). That appears to be how genes work their (in this case) dark magic. Other factors which come into play are Adverse Childhood Experiences such as PTSD, childhood abuse, perceived high stress levels, depression, etc. Here are a few quotes from “Uppers, Downers, All Arounders” (Fifth edition p. 69-70) by Darryl S. Inaba and William E. Cohen:
“The environmental influences that help determine the level at which a person uses drugs can be positive or negative and as varied as sexual/physical/emotional abuse, stress, love, nutrition, living conditions, family relationships, nutritional balance, health care, neighborhood safety, school quality, peer pressure, and television. Interactions with the environment, particularly home environment, actually make new nerve cell connections and alter the neurochemistry a person is born with, thereby helping to determine how that person will use psychoactive drugs.”
“Environmental influences have the greatest impact on the development of the brain. Though we are born with most of the nerve cells we will ever have, about 100 billion neurons in the brain alone, environment influences the 100 trillion connections that develop between nerve cells. In this way environment helps mold the brain’s architecture and neurochemistry, thus altering the way the brain reacts to outside influences. The growth and alteration are especially influential in the first 10 years of life.”
Heredity, environmental influences, and being exposed to drugs (especially at a young age) are the three things which come together, in myriad unpredictable ways, to determine whether a person uses drugs, abuses drugs or becomes addicted to drugs. Exposure is the one thing an individual has control over. We each determine whether we will take that first drink or use that first drug and we determine whether we will repeat that experience. Almost all of us in this culture, by which I mean modern western civilization, do repeat that experience. For some of us the results are disastrous because our heredity and our early environment make us overly susceptible to the effects of those drugs.
For those of us with these predispositions, who have fallen into addiction, we have created an artificial hunger. The drugs we crave become more important to us than food, sex or family ties. During the early stages of our addictions, especially, asking us not to use or drink is like asking a starving person not to put food into their mouths. If a person is dying of thirst and you put a glass of water in front of them they will drink. They will drink if you threaten them with prison. They will drink if you tell them they will lose their spouse. They will drink if it causes them to lose their job. They will drink. The astounding thing is not that people fall into addiction; the astounding thing is that they can stop and rise above it.
What can I do?
No one can make a person change their behavior if they are not ready to change it. You can, however, create conditions which will help the person see that change is desirable and to motivate them to begin the process and to follow through with the necessary modifications they need to make to live a clean and sober lifestyle.
Be honest: Tell the person how their addiction is negatively affecting your relationship with them. Don’t tell them what’s wrong with them. A person dependent on drugs does not need to feel worse about themselves. Lower self-esteem usually leads to increased use.
Set limits: If their addiction could be a deal breaker for the relationship, let them know that. Tell them what consequences there will be if the behavior keeps up: be specific; set dates: “If you are still using by Feb. 1, I will have to (1) stop seeing you (2) distance myself from you (3) fire you.” “If you are still using by Feb. 1 I would like you to agree that you would enter a live-in rehab. If you do not agree to that you cannot live here any more. Emphasize that it is what the person is doing, not the person, which is the problem.
Have them do a Cost/Benefit analysis: This tool is useful for motivating people to stop using and for allowing them to see that they are slaves to their short term desires. We also find it to be a useful tool to retrain those primitive, pre-language parts of your brain which have been compromised by the addiction. A person’s cortex, which weighs consequences and uses language, already understands that addiction is harmful to their lives. Unfortunately, the nucleus accumbens and the ventral tegmental area (VTA) are the seats of addictions. These areas of the brain are in charge of learning and developing habits and motivating us to get off our butts and cater to basic needs like reproducing and feeding ourselves. Addictions co-opt these areas of our brains. Evolutionarily, they are pre-cortex and pre-language, so, the problem is, how do we communicate with them and bring about change? Enter the CBA. At our meetings, we recommend that people do one each day for the first 30 days after they stop their addiction. We recommend they write it out long hand because when you write things out long hand you use the muscles of your hand, your eyes, and you feel emotions when you write about all the negative consequences of your addiction. This is one way to communicate with the pre-verbal brain. We also recommend that if they get an urge to relapse they write out a CBA before they go into the liquor store or go to their dealer’s house. If they still want to drink or use afterwords, that is their choice, as long as they keep their commitment to themselves to write the CBA first. Usually around day 15 most people find they are developing an actual distaste for the addiction. They will also be able to realistically evaluate the damage that is being caused by their addiction. You can use the one provided by the link or you can just have the person draw a line down the middle of a piece of paper and on the left side have them write down all the advantages of using and on the right side all the disadvantages. When they are finished, have them put an “L” next to the Long Term advantages or disadvantages and an “S” next to the Short Term advantages or disadvantages. Voila: the CBA!
Help motivate them by asking questions: “Do you think you can stop? If you think you can, when can you stop? Can we set a target date?” The more specific the better. The more they are a part of the decision-making, the more they will take responsibility for their recovery. This is Motivational Interviewing.
Addictions are like tics from outer space. They will get bigger and bigger until they blot out the world. Base your interactions with the person, as much as possible, on how they will affect the addiction. Do nothing which will help them use, do whatever you can which will help them stop. Don’t allow your world to be blotted out by a giant tic.
From SAMHSA or The Substance Abuse and Mental Health Services Administration:
Motivational Interviewing and the Stages of Change
People go through a series of stages when they change health behavior. The stages are cognitive and behavioral. In the early phases, people tend to focus on thinking about change-whether change is something they need to consider. In later stages, people are actively doing things to change or maintaining the changes that they have been able to make.
The Stages of Change Model has six phases:
- Pre-contemplation: Avoidance. That is, not seeing a problem behavior or not considering change.
- Contemplation: Acknowledging that there is a problem but struggling with ambivalence. Weighing pros and cons and the benefits and barriers to change.
- Preparation/Determination: Taking steps and getting ready to change.
- Action/Willpower: Making the change and living the new behaviors, which is an all-consuming activity.
- Maintenance: Maintaining the behavior change that is now integrated into the person’s life.
- Relapse: A normal part of change until the new lifestyle is fully adopted and has become stable.
- Stable: Not counted as part of the process of change, since it is what lay on the other side of change. Change has been accomplished.
The Stages of Change Model describes five stages of readiness and provides a framework for understanding the change process. By identifying where a person is in the change cycle, interventions can be tailored to the individual’s “readiness” to progress in the recovery process. Interventions that do not match the person’s readiness are less likely to succeed and more likely to damage rapport, create resistance, and impede change. Anything that moves a person through the stages toward a positive outcome should be regarded as a success.
The Stages of Change according to Jim
- Pre-contemplation: Life will whisper to you. Life will shout at you. Life will slap you on the side of your head. Your job is to listen to life.
- Contemplation: Life will whisper to you. Life will shout at you. Life will slap you on the side of your head. Your job is to try to decide what you should do with your life.
- Preparation/Determination: You have listened to life and decided which direction you want to go. Your head is ringing. Make a detailed plan to get from where you are to where you want to be. There are many who have traveled your road who can guide you. Your job is to temporarily disable pride and arrogance. They have ceased to serve you. What you are doing has stopped working. It is the time of change.
- Action/Willpower: Follow your plan. Keep your eyes and ears open so you can learn from others and from your own mistakes, and be flexible with your plan. What works is your guide.
- Maintenance: Sail on. Make life interesting and rewarding for yourself. Do things which enhance your pride and increase your sense of self-worth. Accept yourself for who you are.
And if they do not choose change?
There is little in life sadder than losing a loved one to addiction. “Was there something more I could have done? How could they have chosen this path?” Ultimately, though their choice was impaired, they DID choose that path. Blaming them or blaming others, including yourself, is rarely useful. There are those who have no help from friends or family who manage to change their lives, and there are those who have the most knowledgeable and helpful people imaginable trying to aid them, but who just can’t seem to make it. Do everything you can to help a loved one trapped by addiction, as long as what you are doing will help them end the addiction or at least not enable it, but understand you can only do what you can do. The most knowledgeable and helpful person in the world cannot guarantee the saving of an individual in this situation. One thing which can be helpful is Motivational Interviewing, which is one of SMART Recovery’s preferred techniques. It does little good to tell someone to change or to try to force them to change, but if people are asked the right questions at the right time, they can understand how their actions are incongruent with their goals and values and this will frequently give them the motivation they need to attempt change. If they are not ready to change now, they might be ready later. If they are never ready, then the void they leave behind is filled with tears, regret, guilt, and finally, with a bit of luck, understanding.
Here are a couple of posts from The Addicts Dad on Facebook, kindly allowed by those who suffered this terrible loss :
I am a father who has lost a child, a friend, a daughter. Because of my daughter’s death I have found the need to reach out to other parents who are also dealing with the loss of a child. I get messages from other parents whose children have also died. They inevitably come to the part of the conversation when I’m asked whether or not i have accepted her death. Like so many who do not understand the depth of pain that a parent lives with after a loss such as this, I always stated that I will not and never will accept her death.
Having just recently made it through the 3rd anniversary of my daughter’s death, and facing another birthday without her and being an emotional wreck, I took the time to think about what acceptance means to me.
As her 25th birthday approaches I find myself in almost as much heart wrenching pain as I was when she first died. I am taken back to those last days of her life, replaying the scenes over and over in my mind. Dwelling on all the “what-if’s” and the “why’s”, feeling my heart sink in the emergency room as I finally realized that my B was gone from this earth.
Now having gotten through those painful first days/ months/years I feel as though I am back to where I started three years ago and am once again trying to find my way along this painful journey called grief. I have come to the conclusion of several things and would like to share what I have discovered.
I tell my friends this: Sometimes it just hits. It’s that time of year for me. I think it’s better to cry, scream, yell, whatever it takes, than it is to stuff the pain inside and let it eat at you. It has to come out sometime, better now than later. We all know that it’s a part of this journey, and we all go through those times. I tend to feel that if I accept Caityn’s death…..which for me meant to stop trying to find all the things that I should have done differently and to stop blaming myself and being angry that she was gone. I also thought that if I accepted the fact that she was gone, then it meant that it was ok with me. That I no longer cared that she was gone from this earth.
I also thought that if I began living again; eating, sleeping, taking care of myself, allowing myself moments of joy, and enjoying the lives of my surviving children, then it would prove to the world that I had moved on. That I had forgotten Caityn and what her life meant to me.
I now find that those things are not at all true. For me, acceptance means that I accept the fact that my daughter is not here anymore because I have no choice. But I do not have to like it! I accept the fact that my life is never going to be the same again because I cannot change it or bring her back.
Everything is different now. Nothing is the same as it once was. I have to find a new normal. I accept the fact that she was a wonderful, loving young woman, and I was lucky to have had her in my life! I accept the fact that the sun shone brighter, the grass was greener, the sky was bluer, and the air smelled fresher when she was here.
I also have come to accept the fact that it’s okay to be sad and to feel the pain. This is the absolute worst loss that any human being ever has to face, and I am doing the very best I can dealing with it now. I have learned to take all the time I need to feel the sadness when it overcomes me. Over time, I will be okay. I just have to get through this ocean of tears first. I accept that it’s okay to miss her and to cry for her. After all, who decides how many tears are enough? There will never be enough tears to show how much I loved this child.
I have decided after three years, that it’s also okay to find a way to live with all my feelings put together. That is the key. I try to accept it, but I don’t have to like it or be happy about it. I just have to do the best I can with what I have left and carry her with me as I move forward.
Quote by Elizabeth Edwards:
“If you know someone who has lost a child and you’re afraid to mention them because you think you might make them sad by reminding them that they died–you’re not reminding them. They didn’t forget they died. What you’re reminding them of is that you remembered that they lived, and that is a great gift.”
My son’s birthday was just a few weeks ago. I thought I would post the following that his younger sister wrote:
It often crosses my mind that you will never see another birthday, feel another cool October breeze, eat another pumpkin pie, or smell the aroma of apple fritters. You loved October and it embodies everything that you were. To many, you are just another addict that made bad choices; but to me, you are my brother. You are the same kid who used to tease me about snakes in the pool, make music videos with me, taught me how to head bang, and instilled in me a love for Nirvana and good music. You died on June 22nd but I can still hear your voice so clearly. I can almost hear your laugh and see those awkward hugs you would give “Jim-bo” at Thanksgiving. You had your issues and demons you struggled with but to those who knew you, you also had your gigantic heart and infectious smile. You could light up a room, command attention, and make everyone fall in love with you.
I am beginning to realize just how emotionally difficult October is going to be, Chris. I think of you every day. We are going to be celebrating your birthday on Sunday. We will celebrate your life and remember you not for the person you became, but the person who you truly were inside. When the weather is that crisp autumn and the sun lights up the foliage, I hope you hear me talking to you.
You were born into the arms of a mom and dad who would have done anything for you. You died on the bathroom floor, aspirating your own vomit. What an illness addiction is.
For some reason, you felt that life was not worth living and perhaps it wasn’t with the type of life you were living. But I can’t help but be angry with your choice. I am sure you know that there isn’t a thing mom, dad, or I wouldn’t have done for you. Sometimes things are greater than us, and addiction is definitely one of those things.
No matter what, Chris, know that I am your sister. I love you. I am wondering how you are doing, if the burden of your illness is gone, and if you are in heaven where you belong. I sometimes get weak and cry, which I know you would not have wanted. I am sure you would have hugged me and told me not to worry but I think that I have earned the right.
I don’t know who you became towards the end of your life, and quite frankly, I don’t care. This Sunday, I will remember you as the smart, charismatic, charming, and witty person I knew you were inside.
It is a shame that some people will never get to experience you but I am blessed to have been your sister, friend, and even partner-in-crime at times.
Rest now, brother. You spent too long fighting. Just know that we miss you every day and you are in our hearts.”
“The news tells us to worry about terrorists and Ebola and whatever else they think will increase their ratings. I understand that these threats are real, but our society is quietly rotting in basements and bedrooms across America. Opiates and methamphetamines are destroying this country from within, stealing the next generation right out from under our noses.”
Marc Alberts: Our little brother
A boy from my old neighborhood died this week. He was no longer a ‘boy’, he was 26, but to me he was still one of the kids. They ran around in the summer as a pack. You could tell where they were by looking for their pile of bikes. Scenes from those days of innocence keep flashing through my head – when they went from one house to another, rode their bikes to the playground or to the store- images of boyhood youth. Now he’s gone. Heroin stole him. My heart is breaking for his mother and siblings. They have already been through so much, having lost their husband and father to cancer four years ago. I’m sure Addiction has also stolen years of this family’s life. I know how Addiction takes over a home, because Addiction has been an unwelcome member of our family for the last ten years.
Addiction is stealthy. It hides in basements and bathrooms and bedrooms. It steals children and decimates families under a cloak of silence. The addicts themselves are embarrassed and guilty and are afraid to ask for help. Parents feel inadequate, trying to figure out where they went wrong, what could they have done better. I was a stay at home Mom for God’s sake, and my firstborn is a heroin addict. What does that say about me? Guilt, silence, embarrassment – these are Addiction’s wingmen, giving it the wind needed to kill our kids, gaining strength in whispers at book clubs and coffee shops, ‘he’s an addict you know’.
It’s time to Stop the Silence. It’s time to Speak the Truth. My son is a heroin addict. I want to wear a t-shirt, a hat, a pin, something. I want a suffering family member or addict to see me in the grocery store and be able to walk up and say ‘me too’. I want families to not feel isolated and alone in this hell that is Addiction. It is everywhere, and we are hiding it because we feel guilty and ashamed. I have seen in people’s eyes in the past that they knew my son was an addict. But they also didn’t know if I knew, and I wasn’t shouting it from the rooftops. So the elephant was with me everywhere I went. We lived in a small town. I was sure everyone knew. I was sure my son’s name was whispered when I wasn’t there. Yet I stayed silent.
My son is in recovery. He has been clean and sober for 16 months. It’s a miracle he’s alive. That miracle cost us a small fortune. True recovery is not cheap and it is not easy. It is not five days of detox, have a nice day. It is not a thirty day stint in rehab, have a nice life. It is a slow, slogging, exhausting crawl out of the muddy nasty pit Addiction digs under you. My son spent thirty days full in-patient, sixty more days at the same hospital in a step down program, and then five months in transition housing and treatment. He moved to a sober house where he has been for the past eight months. None of this was easy for him. He dug deep and worked hard. He would not have been able to do this without the support he had along the way. He recognizes that he will need that support for a very long time if not forever. He is beginning to see light and a future, but it certainly didn’t happen during his first thirty days – or even the next ninety. Time is the key, and time costs money. We spent a huge chunk of our life savings to buy him the time he needed. It was a scary gamble for us, but we chose to bet on our son. We’re grateful and thankful he chose to double down on that bet for all he was worth. We were lucky we had the ability to throw those dice. A huge percentage of addicts don’t have anyone (or have burned out the people they used to have) with the resources to get them the help they need.
My son had an Anthem Blue Cross/Blue Shield PPO plan. It listed addiction recovery as something they cover. It listed detox and hospitalization as something they cover. I have in my possession a letter that states the diagnosis is heroin addiction and can be treated outpatient. Detox, denied. Inpatient rehab, denied. Anthem’s medical plan did not pay one dime of his treatment costs.
Recently my son accompanied someone who asked for help to the ER. He had relapsed and wanted to get into detox. There was not a single bed in any detox facility in the state, for any price. He had to wait almost a week for a bed to open up. In that week this young man stayed safe by staying on the couch in my son’s sober living house and not spending one minute alone. Kicking addiction takes a village, but addicts need a ticket into that village, and they are few and far between – and very very costly.
How are we to deal with this epidemic if we as a society leave these addicts out there to die? We all pay the price of this epidemic. Banks, gas stations, convenience stores are being robbed at gunpoint. Home invasions, car break-ins, shoplifting, and credit card fraud are all ways addicts are feeding their habit. For the families of addicts, we get to go looking for stolen possessions – sister’s jewelry, brother’s amp- at pawn shops, or we reach to pay for something only to find our money is gone. Let’s not forget the children of addicts. They pay the highest price.
The news tells us to worry about terrorists and Ebola and whatever else they think will increase their ratings. I understand that these threats are real, but our society is quietly rotting in basements and bedrooms across America. Opiates and methamphetamines are destroying this country from within, stealing the next generation right out from under our noses. Kids who should be going to proms and football games are stealing from their parents, dropping out of school, and starting on a path that ends with jail or death. They are our future, and we need to start fighting for them.
The front line of this fight is to Stop the Silence. Scream the Truth. Let people know that Addiction is in their own towns. It walks the halls of their schools and sits beside them in their workplace. It is teaching their children, driving their buses, policing their streets, and killing their neighborhood children.
If we stop the silence, people will start fighting this battle together instead of feeling ineffective, isolated and alone. If we speak the truth, society will begin to recognize the crisis we are all facing as this epidemic of Addiction stops hiding behind walls of silence and is driven into the light. If we start the conversation, we as a society can put our efforts toward a solution.
Share your story. Let people know how Addiction has touched your life. It has probably touched their lives as well. Help save our children.
My son is a heroin addict.
Stop the Silence. Speak the Truth. Start the Conversation.
My son Kurt, age 7
Kurt today, age 29
Patricia Byrne is from Canton MA and lives in Westminster CO
I dreamed of a long lost love Carried away on the satin sheets of death I saw her, I heard her, I smelled her And then awoke to emptiness and loss
She could not leave behind the life she lived And ended up leaving me and life behind She couldn’t find a way to choose She didn’t know she had a choice
The addict’s life narrows as time moves on, and their horizon becomes limited to the screaming need of now. It becomes almost impossible to contemplate next week and how you would like next week to be, because the need of now requires all of your attention and all of your will. They will risk death, theirs and yours, to satisfy the now. They will be motivated to change only when they believe change is possible and a better future becomes apparent.
“Alexandra Leaving” by Leonard Cohen
Sung by Leonard Cohen and Sharon Robinson
Suddenly the night has grown colder.
The god of love preparing to depart.
Alexandra hoisted on his shoulder,
They slip between the sentries of the heart.Upheld by the simplicities of pleasure,
They gain the light, they formlessly entwine;
And radiant beyond your widest measure
They fall among the voices and the wine.It’s not a trick, your senses all deceiving,
A fitful dream, the morning will exhaust –
Say goodbye to Alexandra leaving.
Then say goodbye to Alexandra lost.Even though she sleeps upon your satin;
Even though she wakes you with a kiss.
Do not say the moment was imagined;
Do not stoop to strategies like this.As someone long prepared for this to happen,
Go firmly to the window. Drink it in.
Exquisite music. Alexandra laughing.
Your firm commitments tangible again.And you who had the honor of her evening,
And by the honor had your own restored –
Say goodbye to Alexandra leaving;
Alexandra leaving with her lord.Even though she sleeps upon your satin;
Even though she wakes you with a kiss.
Do not say the moment was imagined;
Do not stoop to strategies like this.As someone long prepared for the occasion;
In full command of every plan you wrecked –
Do not choose a coward’s explanation
that hides behind the cause and the effect.And you who were bewildered by a meaning;
Whose code was broken, crucifix uncrossed –
Say goodbye to Alexandra leaving.
Then say goodbye to Alexandra lost.Say goodbye to Alexandra leaving.
Then say goodbye to Alexandra lost.
“Long Road” by Pearl Jam
Eddie Vedder and Nusrat Fateh Ali Khan
And I wished for so long. Cannot stay.
All the precious moments. Cannot stay.
It’s not like wings have fallen. Cannot stay.
But still something’s missing. I cannot say, yeah.Holding hands are daughters and sons.
And their faiths are falling down, down, down, down.
I have wished for so long. How I wish for you today.Will I walk the long road? (the long road) Cannot stay. (the long road)
There’s no need to say goodbye. (to say goodbye)All the friends and family.
All the memories going round, round, round, round.
I have wished for so long. How I wish for you today.And the wind keeps roaring. And the sky keeps turning grey.
And the sun is set. The sun will rise another day.I…I have wished for so long. How I wish for you today.
I have wished for so long. How I wish for you today.Will I walk the long road? We all walk the long road.
Will I walk the long road? We all walk the long road.
Will I walk the long road?
Will I walk the long road? We all walk the long road.
Will I walk the long road? We all walk the long road.
Will I walk the long road?