One of my patients has been struggling to overcome a drinking problem. He underwent treatment last year, and stayed sober for six months. Then he went to a dinner party and decided to have a drink to be social. But one drink led to another, and he suffered a relapse. Now he’s trying to quit again.
“Why is this so hard?” he asked me recently. “Why can’t I just stop?”
Anyone who has struggled with an addiction knows how hard it is to quit. Just say no? It turns out that such an approach to treating addictions never made much sense. Scientists are learning details about the biology of addiction which make it clear that addiction is a chronic illness. It’s not the product of bad character or weak moral fibre. Rather, it results from brain circuits being on the blink.
Addictive substances, as many researchers have noted in recent years, commandeer the brain's reward system and undermine people's determination to make wise choices, even when they know they are likely to suffer as a result.
Since faulty brain circuits don't return to normal right away, if ever, detoxification is rarely enough to keep someone sober. Long-term treatment is essential, and usually requires psychotherapy (to provide emotional support, enhance motivation and reduce stress) along with medication to counter the brain changes shaped by the addictive drug.
A feature common to all addictive drugs is that they stimulate the release of the chemical messenger dopamine into a cluster of nerve cells deep in the brain called the nucleus accumbens. This yields a sensation of pleasure that many people want to experience again and again. Cocaine and other stimulants cause this change directly, but other substances — alcohol, narcotics, nicotine and marijuana — all do so at least indirectly.
Could we ever find one treatment to cure every addiction? Probably not, because the cycle of addiction is too complicated — it upsets a dynamic balance between reward circuits and fear circuits. Addiction also stifles activity in the front part of the brain, where people decide what action is most important for survival. Multiple chemical messengers and their receptors are involved, not just dopamine.
The good news is that scientists are well on their way to understanding how addiction changes the brain. This knowledge already has led to treatments that work, such as the development of anti-craving medications that blunt the effects of addictive substances in the brain. However, the best treatment approach remains a combination of medication and psychotherapy over the long term.
Have you or someone you know struggled with an addiction? Which treatment approach worked best for you?
Discuss addictions and A&E's "Intervention" at familyaddictions.gather.com.
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Comments: 46
This time, it has been over a year. What did it?? The threat of losing the love of my life. He said stop or we are done. So I stopped. I haven't done the AA bit or really anything other than be aware of my triggers and learn to work through the issues that made me run to drink in my past.
Do I have it licked?? Hell no! I am aware of how much I have to lose and that keeps the gremlins at bay:)
"the trick is not to try with all your heart to do without, you must put something in its place".
But let me tell you my side....
With all due respect Doctor, I get the fact that the medical community needs a viable "Medical" excuse to explain addiction, simply because society needs to feel safe. When a "professional" gives an opinion or states "supposed" fact society accepts that, uses it or not and everyone is happy......
Well, I realize that I am only one, and everybody is different (although, not really) but I must say.....kickin addiction is a peice of cake......
I stoppped cold turkey from a 12 yr Cocaine habit that at times had escalated to over $500.00 a day.
I stopped smoking cigarettes cold turkey.....2 pk a day habit.
I cut down on my drinking from a 12pk to 2-3 cans a day, from a 5th of whiskey to hardly any except on the weekend....And I'm quite sure if I wanted to stop that completely, I could. That just happens to be a luxury I am not willing to give up at this time.
I think it does a great disservice to the public to make excuses for them by saying that it is a sickness and you HAVE to find TREATMENT....
My wife and I often argue about the fact that she is addicted to Zanax because of her panic attacks....She claims "No Way" could she just stop cold turkey, I say bull s**t...It's "Mind over Matter"..............."If you don't mind, It don't matter"...
I quit two of the most addictive drugs known to man, with nothing more than willpower, granted the birth of my daughter motivated me, but the fact of the matter is that in itself goes to show that what k anne said and what I'm saying is true.....
MIND OVER MATTER....If your are a weak person (mentally) you probably will need help. But overall most normal people have the capacity to do it on their own with little or no help or side-effects....
We have enough dialogue that convinces kids and adults alike that if you have a problem go see a therapist, go to rehab.....How bout telling them to just take responsibility for their actions, pull their heads out of their asses and get their shit together......It really not that hard!!!!
By the way Bert, as much as I hate to admit this.......On this one point ONLY, the Church is right...."It's your choice, Just stop"!!!!! Screw AA and all the rest of that crap, it a crutch you don't need if you are serious about quitting..............
Some may find this unbelieveable; but my mom was a crazy alcoholic over twenty years ago. She started drinking when she was thirteen. She tried and she tried to stop. The God honest truth: she accepted Christ as her savior December 12th, 1983, and has been alcohol and cigarette free ever since. None of her friends believed it. My mother was the party-hearty type! She gave the parties; she went to parties; she was the party. And, in one night, her life changed. Everyone couldn't believe it. But I did. Because I lived it. And, it even took me awhile to believe it would last; seeing how she had tried and failed so many times before.
I truly believe it depends on the individual and their environment, and a certain set of circumstances. I truly don't believe that the majority of these people want to live this way. So, perhaps it is true: they just can't help themselves.
Couldn't have been said better....Not just sobriety though (alcohol, drugs) anything that causes addiction can be added to that list.....
Don't you think there is an hidden agenda here?......................I'm quite sure that segment of the medical community has a stake in "You, the public" believing that you can't stop without help....
Kinda like, you won't go to heaven, unless you give your heart to God.....
Can you say "BRAINWASHING".......
Kinda like scare the masses to the point they feel there is no hope without help, now bitches, open your checkbook!!!!!!!
it is hard to read that some people think that people who work in the treatment field do it for the money. it is a very poor paying occupation. as a substance abuse counselor with a master's degree i could more than double my salary in a different type of facility but my passion lies with this field since i saw so much addiction in my family. i am not in recovery but have been in the field for 7 years and realize that if it were only will power that could make the difference then most of my patients would have gotten clean/sober long ago. they suffer, they know they cause their family to suffer but they cannot do it alone. i am grateful that the medical model is accepted so that people can get treatment and are not so likely to be judged as morally deficient or lacking in will power. whatever the reasons, treatment works well for many individuals. aa/na helps thousands of people remain clean/sober and so i recommend it highly.
For years people were told there is no withdrawal from SSRI's. Now, a good doctor will tell her patients about the range of symptoms. Some people have none. For others the symptoms are serious. Sometimes I think the variations in the biochemistry of individual humans one from another can be as much as that between some species.
Withdrawing from benzo's is particularly dangerous. When budget cuts caused abrupt withdrawals some years ago in Oregon, a man died of withdrawal-triggered seizures. That one made the news. But one of my clients who was active in mental health communities knew of cases that never did make the news.
It is unwise to withdraw from these medications without a great deal of support and reducing very gradually over time. It is worth doing this because anti-anxiety meds work by interfering with memory and cognition. Those who value an ability to reason and remember should move to get off these meds; they just need to plan for a tough transition period
A caffeine-withdrawal headache is one thing. Seizures from withdrawing from some meds are a different case altogether. These are not petit mal. These seizures can go beyond grand mal. I am so serious about this. Withdrawing cold-turkey from some legal medications can be a major life-threatening event. Of course, staying on the meds is life-threatening as well. It's a choice.
Similarly, athletes who are injured and can no longer do the long and vigorous work-outs they are used to are at grave risk of depression. It is best for someone close to them to tell them.
I can't tell you the relief I hear in the voices of the people I explain this to who have had exactly this scenario go down. They can tell themselves all sorts of nightmarish things to explain how awful they feel. When it is explained that they are withdrawing from the opiates and other biochemicals their own bodies were making, well, the sighs of relief are audible over the phone.
I wish there were a way to make this sort of information available to everyone who needs it. As it is, it's catch as catch-can. If you know someone in one of the trades who knows about this stuff, you are blessed indeed.
The same goes for going in-patient in a hospital for anything at all. Patients need strong advocates who will stay with them. It is a physician speaking on NPR who made this very clear.
The new job title of people who do this for a living is "hospitalist." Two big issues are cleanliness and medications. Anyone unconscious in a hospital is best off having a person well-informed on these two issues present at all times.
Click
By Marion Jones
(Recovery)
I was too scared to go outside; looking just that bad all I did was smoke and hide. I would wait until it got dark, because that is when the party starts.
But in the back of my mind something goes....
Click.
I can remember chasing the high of my first hit. Lost my whole paycheck, went into debt, and at the end having a fit. Constantly in and out of rehabs with no self-esteem, blaming everyone else for my drugging, I just did not want to stay clean.
Got a moment of clarity and something went....
Click.
It happen, I could not take it no more. With the Lord's help, I was able to put that pipe down and walk out the door. No more do I have to wake-up sick.
Listen... listen, do you hear it? ... ssshhhh, there....
Click.
Copyrights 2007 Marion Levi Jones Recovery Inc.
k anne,
Believe me when I say that due to my wife's condition I have researched the condition and the drug extensively...And yes, I have read on more than on occasion that the withdrawl from Xanax can be a MFer, and that possible seizures can occur....It's funny though, when she got pregnant she stopped cold turkey without any complication or symptoms what so ever, no to mention that she didn't have a single panic attack for 9 months...
Now, I assume that can be chalked up to the fact that a woman's body goes through extreme changes during pregnancy and that the chemical imbalance in her brain that causes the panic/anxiety attacks was some how balanced out due to the pregnancy.
That coupled with the fact that she knew without a doubt, no excuses, no bullshit, that she HAD TO STOP talking those pills for the babies sake...
The calm lasted about 6 months or coincedentally once Cheyenne stopped breast feeding...Liz knowing at that point she could safely take the pills again, began having panic attacks and of course resumed her use of the Xanax...
I appreiciate your input and I have no doubt you are 100% correct to a certain point. But, I have seen too many people clean up real nice...From Heroin, Cocaine, meth, Xanax, pain pills....etc etc....and almost exclusively it came from them deciding that it was "Time to Quit"....So it's just a matter of whether or not you have the intestinal fortitude to ride out the misery of becoming normal again....
Claire,
I realize the therepists/councelors don't make squat, but the facilities are raking in the bucks, I not talking about state run/Govt run facilities, I'm talking about private ones...You know, the little 30 day vacation/retreat villas that charge upwards of 2-10 thousands dollars a week just to check in. And then pamper you like a rock star while your there.... Every little Brittany wanna-be in Hollywood is a "Poster Child" for what a waste MOST Rehab facilities are...You do honorable work, and far be it for me to disrepect you by saying what you do isn't needed, obviously it is...My point is...It shouldn't be (needed). People need to stand up and take responsibility for themselves and their lives, inner strength and determination is something that in today's world is sorely lacking in this and former generations....Most kids from 18-35 wouldn't have a clue as to what I am talking about.
Thanks to Al-Anon, which was recommended to me by a therapist, I am able to both understand the nature of alcoholism better and my own contributing behavior. I now know that I didn't cause it, I can't control it and I can't cure it. It's not my responsibility. It's his. And I am grateful for that information. I hope he decides to get help someday, not for my benefit but for his own and his daughter's. I will not stay forever with an active alcoholic. There will always be a reason to drink, whether I stay, or go. He needs to quit because he wants to, not for anyone or anything else. Some people never hit their bottom, their bottom hits them first and that is death.
We all have character deficiencies, I call it lack of maturity, either emotional, psychological or spiritual in various degrees. Not unusual. life is constant change.
The self esteem we have been told we should have is achieved by accomplishments, ability to accept ourselves as we are and a desire for growth with no comparison to others. Acceptance of pain and suffering as a part of life and enduring hardship without using drugs helps to build the inner strenght allowing us to make better decisions.
Empowerment is knowing you are in charge of your brain and the response you give to what happens to you.
The brain is a gland, so what gives the brain its response...the mind.
When an individual learns to think rationally, use reason,develops a philosophy of life according to the principles he has chosen to live by, then the mind is engaged in telling the brain how to respond.
A mindful individual is not just educated, he is a moral being and a spiritual being.
He is a capable of changing his way of thinking in a moment when he realizes that the power over the brain responses is in his hands.
I grant that serious cases need to be medically supervised but it is not just the body we need to cure, it is the mind and soul we need to heal.
One day we will understand how an individual born free and full of life becomes enslaved and embittered by life circumstance to choose to poison himself with drugs.
Nature 's wonder is that our brain is capable of releasing endorphins, more powerful than cocaine and non addictive, yet so few take advantage of them and learn how and what to do to release them. Live joyful and learn how.
I'll stick with what M. Scott Peck says on the subject, "every human being on the planet is broken in some way. Alcoholism is a blessed addiction because it visibly breaks people and forces them to come together in the form of community to confront their broken-ness"! God help the people who never discover they are broken! They are the real tragedies in this world.
Spartan,
Hold that thought......You and me gonna DEBATE over this one.....It's too late right now....But I will be back tommorrow.............
I can't possibly respond to everyone individually, so I'll try to pick up on a few themes here.
One key theme, I think, is the lively disagreement between people who think one can "just stop," and those who see the problem as much more complicated. I am with the group that sees it as very complicated.
Do any of you remember the "Just say no" campaign that Nancy Reagan championed in the 1980s?
During that period, I saw a comedian (don't remember who, I'm afraid) who was poking fun at that campaign. He referred to the Nancy Reagan comment, then said -- now their starting a similar campaign for the homeless and the slogan is, "Just get a house!"
For the people who can just say no, that is fabulous. You understand the dangers of addiction and just put the brakes on. The reality is that for people who are truly addicted, the brakes are broken. So it is simply impossible for them to just say no without considerable help.
Now -- I do believe that sometimes "I can't" becomes a way to avoid getting help, or treatment. But it is very hard to tell when someone is simply sticking their head in the ground, or if they're overwhelmed. My bias is to assume that if someone says, "I can't," they're saying it for good reason.
Here I'm with the people who say, whatever works for you is the best approach.
The evidence is that no approach has been proven to be absolutely better than any other. Experts in the field who look at the evidence very carefully point out that people find many different routes to abstinence. Many find their way without formal help.
AA, by the way, is not better than other approaches, but it has the distinct advantage of not costing anything. It's a great approach, time-tested, but many, many people don't find it helpful. Those who don't like AA, however, should be reassured that there are many ways to get help.
She wrote, "I find that, the ones who had stable and constant support, encouragement, and not enablers--and given accountability, they soared in their efforts to beat the addiction, and have been successful for many years." Then later, she adds, "I truly believe it depends on the individual and their environment, and a certain set of circumstances. I truly don't believe that the majority of these people want to live this way."
I'm very comfortable with that viewpoint. I think we're all trying to do the best we can. We can do better if we (and the people who care about us) stack the deck in our favor. And Ruthe gave us a great list of things that help: support, encouragement, holding us accountable (without being punitive), and recognizing that some days maybe we can't help ourselves.
There's some recent evidence that people who combine a variety of approaches may have a better chance of succeeding. For example, combining AA with psychotherapy and some pharmacological treatment might work better for some people because they're coming at the problem from several angles.
The hope is, by getting more kinds of help, it makes it easier for us to help ourselves.
I think some people think that nobody cares so they keep drinking.
How can someone who has everything to lose.... NOT want it?!?!?!? Not trying to be smart or funny here. I've known several people, a few VERY close to me, to have chance after chance... knowing that they were about to lose everything.... trying to stay sober, even going through treatment centers... out patient therapy... private counseling....AA meetings every nights....staying sober for days, weeks, months at a time but them drinking. :o(
I really do think there's more to it that just "wanting" to stay sober. Yes, it's a great factor. If a person doesn't want it, they surely won't stay sober. BUT I do think sometimes someone wants to... but for some reason.... can't. Maybe chemical imbalance or emotional scaring that has caused the brain to not function improperly??? I think being willing to research it, getting different opinions and then a proper diagnosis is important.
Each individual is a unique case. To say that all it takes is really wanting to..... could be fatal to some.
Another comment: I think that sometimes we forget that drinking and using other drugs is pleasurable. It is hard to imagine that someone would not want to stop using substances when they have made a mess of their life by using that substance but then there comes the reality that the person has learned to cope with everything by using drugs/alcohol. When they are happy, they use; when they are upset, they use; when they have stayed clean/sober for a while, they feel that they deserve "just one." I don't understand how Spartan can say this is not a complicated issue. If it were just a matter of deciding not to use, we who work in this field could just say "you merely need to want to be clean more than you want to use" and you'll do just fine. Many of my patients want desperately to be clean but they don't know how to do that. They are addicted to the substance physically, their lifestyle involves hanging around with other addicts/alcoholics, they have often worked by selling drugs. In order to find their way to wellness, the person has to learn new coping skills, develop a sober support network, find a job in which they can use their (often excellent) sales skills in a healthy way, etc. It's not simple in my mind; it is a journey of change.
He'd asked me that day to try and quit, as a test, a challenge, to quit for six months, three months- hey- how about 30 days- you can do it.
I sat listening, thinking, why don't you ask me to hold my breath for 30 days- I'd have as good a chance of succeeding. That's how hard it is. An addict can not picture himself not imbibing, consuming his daily doses. I could not imagine arising from be the following morning with the thought: No Alchohol for me today. Are you sick? What kinda sick joke are you trying to make with me here? The image is just inconceivable.
But I did quit that summer, for 44 days in fact. It took a camping trip, our usual family, end of the summer, labor day 4 night trip to bring me back. I told myself I'm bring these 2 fifths of bourbon only to help me sleep on the hard ground, to better handle the cold mountain temps of Idaho's central highlands- and I will not touch them until after dinner, after dishes, after sundown. And I won't bring anything back home with me.
Well, I kept all my promises; consuming exactly 1/2 bottle of Jim Beam mixed 50/50 with water every night. I did sleep soundly, didn't notice the cold. Didn't hide it from my wife- in fact shared with her. Didn't bring any back.
A week later, at a carnival, I succumbed to thirst and drank a large, plastic, $4 glass of beer. I was back in business.
That was in 2001. In 2003, I began swelling like a water ballon being filled at the faucet. Gained 50 ponds in 2 months. A trip to my local Veteran's Admin Hospital found that I had Hapatitis C; generally accepted as incurable when past its early stages. Like mine. It turned out that the HepC had probably resided, quietly in my body for years. Who knows how I first contracted it, but my drinking and its insuing liver damage had weakened the organ enough to wake up Mr. HepC. Now I had full blown cirrhosis- with the HepC aggravated by alchohol poisoning.
I had another chalenge- quit now or die in months. Now that's a challenge all but the most far gone can hear.
Yeah, I quit. Call it cold turkey, because that's the way it was. In reality, though, I was already sick- even dying, and I was near death for several months before my meds and my abstinance made their presence known. Yeah, in the hospital for overnight stays, emergency room twice, but am now as well as can be exoected to get. I continue to take ten, count 'em TEN (10), prescriptions a day. Though one is to help me sleep and another is to keep my stools loose- though not a laxative since I need a long term fix and laxes aren't made for that. I take two seperate meds to Force me to pee. Thusly I keep my weight off- actually the pounds are due to fluid retention on account of my very inefficient liver.
It's been nearly four years now, with no serious temptations- literally- I don't even think of having just one drink- not even a little one- anymore. In truth, at a wedding last summer I picked up a small paper cup,- I swear it was from the children's side of the table and supposed to contain sparkling cider. It was champagne, which I knew immediately upon tossing it down following the toast to the new couple. But, what the hey, I told myself, I'm not a drinker- and this ain't drinking. I told no one of the incident, but my daughter had been watching me and did see. She later brought it up in front of my wife and I, but not in a punishing, chastising manner. She said she's watched me the rest of the long night and didn;t see me take anything other than my usual Diet Coke again. Though all around me people were drinking; from the keg of beer, from numerous wine bottles and champagne, too. Now she believed I was no longer a drinker, too.
Am I lucky? Lucky to be a successful quitter? I am alive, though my Doctor keeps reminding me to get on the liver transplant list. At least a year's wait- for everyone they say- no buy yourself to the head of the line- yeah right- ain't that right Mr. Mantle sir?
But addiction makes another bad entrance. One may not get on the liver donor list if one has been smoking in the last year. My Doctor keeps me cognisant of that.
And I simply can't imagine myself no smoking. Ever.
Read this and weep for all practicing addicts. They know not what they do.
What's New?
I agree with the statements above: Until a person acknowledges a problem AND wants to overcome it, no amount of treatment will be successful. The person does need to be treated holistically (physically, mentally, socially, and emotionally).
The Globe---What's New?
Sean Cruz
Drug Intervention
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Karen Walter
Idaho Drug Treatment Centers
The initiative taken for the concern is very serious and need an attention of every one. This is the concern which exists in the society and needs to be eliminated from the society as soon as possible.
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Henry Pollick
Debit Machine Canada