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Drugs & Alcohol: The Hard Addictions

Drugs & Alcohol: The Hard Addictions
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Drugs & Alcohol: The Hard Addictions
Guided Practice

As an integrative psychiatrist, I am here to help people with all types of life challenges, but my true area of specialization is treating people with addictions and addictive behaviors. (Notice that I don’t use the word “addicts,” because an important thing to realize is that a person is more than their addiction or addictive behavior. One who has lost control over his or her life due to substance abuse issues is still a person – a mother or father or sister or brother, a bus driver or a motivational speaker or an artist, etc.)

Historically our culture stigmatizes and judges addiction, but I believe it is important to start with the understanding that this is not a path that anyone ever sets out to take by choice. Finding yourself with an addiction to drugs or alcohol feels awful, but it is never too late to change, heal and redirect your life to a more purpose-driven path. The first step in that direction is realizing that your use of drugs or alcohol no longer serves a purpose or solves a problem but has, in fact, created bigger problems in your life.

There are three main reasons why people start using drugs or alcohol:

  1. Recreational use – to lift yourself up from everyday life.
  2. Self-medication – to dull or drown emotional or mental or physical discomfort or pain.
  3. Performance enhancement – because you believe that the substance helps you to do what you do better, whether socially, mentally or physically.

Addiction Changes Your Brain

By the time one becomes dependent on a substance, the brain has actually changed. The reward circuitry has been altered. This is the reason why addiction can be so difficult to overcome and it’s the reason why abstinence – completely staying away from your drug of choice – is so hard, especially in the beginning.

Here’s what happens: The human brain has a built-in reward circuitry that drives us – production of a chemical called dopamine, the feel-good hormone. When you feel pleasure, it is because dopamine has been released in your brain.

  • Our brains were never designed to be flooded with dopamine, however. It’s like dessert – a reward meant to be enjoyed in small, intermittent doses so it’s something we can look forward to. We taste something delicious and we say, “mmm, that’s delicious.” A bit of dopamine gets released. Dopamine is associated with sexual activity too – it’s there so that we do the things that we need to do, as humans, to carry on as a race.
  • But when the brain gets flooded with dopamine (because a person is drinking or abusing drugs so much and so often) it down-regulates the reward system. The brain can’t control how much you drink or the drugs you take, but what it can do is control the receptors to which the dopamine binds. The end result is that the brain down-regulates the dopamine receptors.
  • So now, let’s move forward and look at what happens when you stop drinking or taking the drug that your body has become so accustomed to.  The brain has down-regulated the dopamine receptors that were being flooded by the drinking and drug use — and altered your ability to feel pleasure.  It’s like a deadening of the pleasure zone – things that used to feel good, like taking a walk on the beach or meeting a friend for dinner and a movie – don’t even seem worth the trouble.

The good news is that with time, the brain can and will heal.  Within about 90 days (more or less) the brain begins to adjust and up-regulate the dopamine receptors.  It’s never too late.

But it’s important to realize that abstinence (not using your drug/alcohol) does not mean the same thing as sobriety.  Sobriety equals abstinence plus “recovery,” which is to track down and address your reasons for using drugs or alcohol in the first place.   Recovery is the work that has to be done to understand why you got where you did, what unresolved issues you need to figure out and what holes you need to fill … and then doing so.

Do you have an addiction?

It’s fair to say that drugs or alcohol have become an addiction if your use has become a repetitive, habitual behavior that is destructive to the quality of your life.

Below you will find information that medical doctors use to identify people with substance abuse and substance dependence. With your journal, take some time to think about each of the criteria listed and how it relates to your life … and then go through the list again with an important shift: Pretend you are a person to whom you are close (your spouse or lover or best friend or parent or child or perhaps your employer) and write down what you think they’d say if asked whether this criteria describes you.  (If it’s not yourself but someone close that you are concerned about, reverse the order of the exercise – first pretend you are that person and then examine the statements from your point of view.)

Write down each statement … your thoughts and feelings from each perspective … and then write a paragraph about how you feel when you’ve completed the exercise.

The medical world uses specific criteria to identify substance abuse and substance dependence.

Substance abuse is the diagnosis if one or more of the following criteria are met within a 12-month period:

  • Recurrent substance use results in a failure to fulfill major role obligations at work, home or school.
  • Recurrent substance use in situations where it is physically hazardous (for instance, while driving a car).
  • Recurrent substance-related legal problems.
  • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or worsened by use of the substance (such as arguments with your spouse or children).

Dependence is defined as experiencing at least three of the following criteria within a 12-month period:

  • Experiencing tolerance, defined as either a need for markedly increased amounts of the substance to achieve the desired effect or a markedly diminished effect with continued use of the same amount.
  • Experiencing withdrawal, as evidence by either the characteristic withdrawal syndrome for the substance or when medication is taken to relieve withdrawal symptoms.
  • The substance is taken in larger amounts or over a longer time period than originally intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  • A great deal of time is spent in activities necessary to obtain the substance (you spend a lot of time thinking about it, how you are going to get it and when you can have/use it).
  • Important social, occupational or recreational activities are neglected or abandoned because of substance use.
  • The substance use is continued despite knowledge of having a persistent or recurrent psychological or physical problem related to substance use