Smoking and Addiction Recovery

William L. White, a well-respected addictions researcher, has published a good overview of addiction recovery and tobacco use. Here are some statistics from White's work: Between 70-80% of people entering addiction treatment smoke—nearly 4 times the rate for all adults. People treated for alcohol or drug dependence are more likely to subsequently die from smoking-related diseases than from alcohol or drugs other than nicotine. Leading figures within the American history of addiction recovery have died of smoking-related diseases, including Bill Wilson, Dr. Robert Holbrook Smith, Mrs. Marty Mann, Danny C., Jimmy K., Charles Dederich, Dr. Marie Nyswander and Senator Harold Hughes.

It used to be an accepted "truth" in the addictions field, based on anecdotal evidence probably in part supported by the fact that most of the recovering addictions counselors smoked themselves, that an individual in early recovery from alcoholism or other dug addiction should not focus on stopping smoking tobacco products because to do so might cause so much stress or lack of focus on the "primary" problem (alcohol or other drug abstinence) that the individual would be in danger of relapse. I can remember back in the day when, believe it or not, we counselors and patients would smoke cigarettes during group therapy in an addictions treatment program. The thinking then was that addressing smoking could wait until the advent of a stable recovery from alcoholism.

Indeed, the basic text (Big Book) of Alcoholics Anonymous suggests that it may be wrong to make a "burning issue" about smoking by a recovering alcoholic when "his more serious ailments [drinking] were being cured in AA (Alcoholics Anonymous, 4th Ed., page 135)."  I do not criticize this early AA view of smoking. The science showing the serious health effects of smoking was not available then and, of course, the AA program by definition is aimed at alcoholic drinking (though I think stopping smoking can be done using the 12 Steps of AA).

Research, has not confirmed the validity of the old approach of avoidance of addressing nicotine addiction in early recovery; in fact, evidence seems to suggest that continued smoking in recovery can slow healing of the brain damaged by alcoholic drinking and may interfere with recovery. Also, addressing nicotine addiction at the same time as alcoholism (or other drug addiction) does not adversely affect treatment outcomes. I'll provide a summary of some of the research here.

1) Active alcoholism interferes with the flow of blood to the brain, probably in part causing the difficulty drinking alcoholics, and those in recovery, have with memory and thinking. In early recovery from alcoholism, brain imaging studies (2009) have shown that the blood flow to the brain of non-smoking alcoholics returns to normal within five weeks of abstinence, while the same is not true of smoking recovering alcoholics.

2) In a 2004 review of 19 research studies looking at the effect on addiction (non-nicotine) recovery in addiction treatment programs that addressed nicotine addiction as part of treatment of the "primary" addictions, "smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs." In other words, "Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety." According to William L. White in his 2011 review, "Smoking cessation in early recovery does not increase craving for or urges to drink alcohol. Continued smoking following treatment for alcohol and drug dependence is a risk factor for resumption of alcohol and other drug use."

3) According to a federal government supported review of research on alcohol abstinence and recovery, "the short-term effects of alcoholism may appear more dangerous than those of cigarette smoking. However, mortality statistics suggest that more people with alcoholism die from smoking-related diseases than from alcohol-related diseases ***. Comorbid smoking and alcoholism result in synergistic exacerbation of health risks (the two conditions work to worsen health risks)."

4) According to a review of addiction treatment facilities (2010), Direct treatment of nicotine addiction beyond just providing a nicotine replacement drug (e.g., nicotine patch, gum) is rare. "About 71% of publicly funded treatment programs and 65% of therapeutic communities did not offer a counseling-based smoking cessation program or any medications, such as over-the- counter nicotine replacement therapy (NRT) or prescription medications (e.g., varenicline, sustained-release bupropion). Programs that relied on private sources of funding, like insurance and self-paying clients, were more likely to offer services, but the predominant approach offered by 41% of private programs was smoking cessation medications without a formal counseling program."

Those of us in recovery from addiction seem to be attracted to any behavior that feels good, such as eating, sex, gambling, and nicotine use, to name a few, all of which can reach the stage of addiction and become destructive. My experience in the addiction field and in my own recovery, is that the recovering individual needs to be on guard for any replacement addiction that may be rearing its ugly head. Nicotine addiction is probably tougher to treat and recover from than many of the so-called primary addictions (alcohol, opiates, cocaine). Gambling on a regular basis, for example, may not result in a sufficient pattern of negative consequences to seriously interfere with the quality of one's life.  However, the known health effects of smoking, even a few cigarettes a day, are so clear that addressing smoking should come sooner rather than later in one's recovery journey.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/27/2013.

Genetic Risks for Alcoholism and Eating Disorders Are Present in Both Men and Women

Researchers in a study to be published in the September issue of the Journal of Studies on Alcohol and Drugs, summarized in ScienceDaily, have found that the same genes may be involved in both alcohol addiction and eating disorders in both men and women. Prior studies had found such a connection in the case of women. The study under discussion is the first to look for a genetic connection for alcoholism and eating disorders in men.

Per the ScienceDaily summary:

"The researchers reported that people with alcohol dependence may be more genetically susceptible to certain types of eating disorders and vice versa. *** "In clinical practice, it's been observed that individuals with eating disorders also have high rates of alcohol abuse and dependence," said Melissa A. Munn-Chernoff, PhD, the study's first author. "Other studies have focused on the genetic connections between alcohol dependence and eating disorders, but all of those studies looked only at women. Ours was the first to include men as well."*** "We found that some of the genes that influence alcohol dependence also influence binge eating in men and women."

It is commonly thought that eating disorders occur only in women, but the disorder also can be found in men. This research suggests that individuals with eating disorders, including men, may be at risk for alcoholism and vice versa, that is, both men and women with alcoholism may be at risk for eating disorders. Those involved in treating individuals of both genders with alcoholism and eating disorders should be alert to the presence of both disorders in their patients.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/22/2013.

Your Reaction to Pleasure May Put You at Risk for Addiction

Researchers in a study to be published in the January 2014 issue of the Journal Alcoholism: Clinical and Experimental Research, summarized here, have found that the way an individual responds to a drink of alcohol may indicate presence of a risk to develop an alcohol problem. By way of introduction to the topic of this research study, I'll give a quick summary of brain chemistry of addiction.

For a number of years now, science has revealed that most drugs of abuse, including alcohol, operate in large part by causing a feeling of pleasure, or a "high", because of the drug's ability to trigger a flood of dopamine, a feel good chemical, in the reward pathway of the human brain. Dopamine is the chemical, also called a neurotransmitter, that is produced when we humans engage in pleasurable behaviors such as sex or eating food, etc. The theory is that production of dopamine can reinforce behaviors essential to human survival such as eating and reproduction. The amount of the feel good chemical dopamine that is produced by using drugs such as cocaine or alcohol is far in excess of that produced normally through natural functions (sex, eating) and the intense pleasure or high produced forms the basis for wanting to get the feeling again by using the drug that triggered the feeling. Or, as stated in fancier language by one of the researchers in the study under discussion:

"For example, in both laboratory animals and people, increased dopamine transmission seems to enhance the ability of reward-related stimuli to grab attention and attract you. This effect likely contributes to why having one drink increases the probability of getting a second one - the alcohol-induced dopamine response makes the second drink look all the more desirable."  ***These DA [dopamine] systems appear to be especially important in determining the degree to which rewards become desired. So, if they are activated to an abnormal degree, this can result in pathological 'wanting' or 'craving' for associated rewards. This is what drugs of abuse are thought to do - they increase DA activity more than what is normal, and when taken repeatedly, the ability of drugs to activate DA [dopamine] systems is often further increased or 'sensitized.'"

The researchers studied a group of social drinkers who were at varying degrees of risk of developing an alcohol problem, and using brain imaging studies, "... found that people vulnerable to alcoholism might experience an unusually large response [to the dopamine feel good chemical] in the brain's reward-seeking pathway when they take a drink" *** "This finding is compelling", said the researchers. "For example, a large dopamine response might energize reward seeking and counteract the sedative effects that are the focus of the intoxication measure. Conversely, people who experience minimal dopamine release when they drink might find the sedative effects of alcohol especially pronounced."

So, we have in this small study another indicator of an area for more research that might result in the ability to find a marker (reaction to pleasure through dopamine) that may predict who is vulnerable to developing an alcohol problem.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/20/2013.

Women Seek Alcohol Treatment Sooner that Men

New research scheduled for publication in the January 2014 issue of Alcoholism: Clinical & Experimental Research, and summarized in a press release here, found that women seek alcohol treatment between an average of 4 to 5 years earlier than men. Prior research has suggested that women may develop serious alcohol problems needing treatment at a faster rate than men, that is, that they might experience a "telescoping" effect, wherein they progress more rapidly through various stages of the disease...of alcoholism. Anecdotally (non-scientific evidence), in the 12 Step Programs it has been noted that women progress to alcoholism at a faster rate (time frame) than men.

One of the authors of the research study stated:

*** "in a moderately large heterogeneous population of drinkers seeking treatment, a telescoping effect is observed. Women, on average, sought treatment between four to five years earlier than men; in other words, 10 years versus 15 years. Although the study does not specifically address why this is the case, it is important for primary physicians and first line health care workers to know that it takes, on average, approximately 10 years to progress from self-reported problems with alcohol to treatment for women, and approximately 15 years to progress from self reported problems with alcohol to treatment for men.

"The bottom line," said the researcher, "is that hopefully these results will raise awareness concerning the restricted time window between alcohol problems and the development of sufficient negative consequences to prompt seeking treatment among women. These findings emphasize the need for greater attention to women's issues, determining sex-specific risk factors, as well as identifying subgroups most likely to require treatment. Additionally, there must be a greater awareness of the importance of intervening when alcohol problems are first experienced. If we are able to develop appropriate interventions, we may mitigate the need for inpatient treatment for some of these women."

As always, comments are invited. Jan Edward Williams www.alcoholdrugsos.com. 08/15/2013.

36 Years of Continuous Sobriety Today!

36 years ago today, I began a recovery journey that has resulted in 36 years of continuous abstinence from alcohol and other addictive substances. I share this here not as a tribute to me but as evidence (even though anecdotal) of how use of simple recovery tools can result in long term recovery. Just briefly, my story is of an individual who, back in August of 1977, was a full blown alcoholic in the latter stages of the disease, but who had no idea there was anything called the disease of alcoholism and who, when offered the opportunity to get sober through the 12 Step Program known as AA, rejected that Program because of the emphasis on spirituality, God, or a Higher Power. After about seven attempts at sobriety in AA, with relapses shortly after intensive hospital treatments, I became willing to go to a long term residential treatment program and willing to seek help from a God I didn't believe in, and try to do the 12 Steps of recovery in AA. Where did the willingness come from after a year of resistance to a spiritually based recovery? I can only speculate that exposure to AA coupled with the ever increasing pain and suffering (loneliness, despair, fear of impending doom, plus physical illness from drinking, such as, seizures, cardiovascular disease, liver disease) caused by alcoholic drinking combined to lead to willingness to try a spiritual way out. These days I would describe the willingness as a spiritual gift.

I'll quote from the AA basic text:

"Most emphatically we wish to say that any alcoholic capable of honestly facing his problems in the light of our experience can recover, provided he does not close his mind to all spiritual concepts. He can only be defeated by an attitude of intolerance or belligerent denial. We find that no one need have difficulty with the spirituality of the program. Willingness, honesty and open mindedness are the essentials of recovery. But these are indispensable. 'There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance—that principle is contempt prior to investigation.' -—Herbert Spencer.' (Appendix II, Alcoholics Anonymous)."

As always, comments are invited. www.alcoholdrugsos.com. Jan Edward Williams, 08/12/2013.

Recovery Slogans: Live One Day at A Time

Let's begin to talk about recovery slogans often used in 12 Step Programs. These slogans are really tools that can be used to support one's recovery from drug or alcohol addiction. Perhaps one of the most important practical concepts for early recovery is the well-known, and therefore, perhaps not fully appreciated, idea of living one day at a time. For the individual beginning recovery, there are so many areas of stress that the individual can easily become overwhelmed at the seemingly insurmountable goal of staying abstinent from the use of alcohol or other drugs. Commonly the newly recovering person will worry about staying away from drug or alcohol use in many situations that will arise in life, such as, a wedding anniversary coming up in a few months, or New Years Eve (8 months away), or giving a toast at a child's wedding (child now 3 years old). Or, how will I eat crabs without a beer, go to a football or baseball game, go on a date, etc. Abstinence in recovery can become an achievable, manageable goal by reducing the task to just not picking the substance up TODAY. Today is truly the only day you have, and is the only day you have to stay clean and sober. You don't have to not use the rest of your life. You need only decide to not use for today. Whatever future situation you are concerned about is not happening today.

The Alcoholics Anonymous basic text (Big Book) states:

"We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition. Every day is a day when we must carry the vision of God’s will into all of our activities (page 85)."

Similarly, the Narcotics Anonymous basic text states:

"Stop using for today. Most of us can do for eight or twelve hours what seems impossible for a longer period of time. If the obsession or compulsion becomes too great, put yourself on a five-minute basis of not using. Minutes will grow to hours, and hours to days, so you will break the habit and gain some peace of mind."

Another way to think about living in the now is this: Today is your past of tomorrow. Facing each day's challenges without using drugs or alcohol will build a solid foundation for recovery that is based on your own personal experience. One day at a time, using all the recovery tools at your disposal, including attendance of 12 Step meetings, finding a source of spiritual strength, getting a sponsor (mentor) in recovery, seeing a counselor or a therapist, and, of course, not drinking or drugging, will not only result in days abstinent but also the evidence based on your own experience that your recovery tools work. Faith based on experience rather than the words of others can be truly powerful. I will end the subject of living one day at a time with a quote from the 12 Step literature that I love. "I will try to live through this day only, and not tackle my whole life problem at once. I can do something for twelve hours that would appall me if I felt that I had to keep it up for a lifetime (Al-Anon-Alateen, Just for Today)."

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/12/2013.

More Evidence that Marijuana Is Not A Benign Drug

University of Maryland researchers in a study funded by the Federal government's National Institute on Drug Abuse, have preliminary evidence that suggests that marijuana use by young individuals whose brains are in the process of maturing may develop adverse effects on their brains' ability to function that may last into adulthood. The study found that adult smokers did not experience the same thinking dysfunction. Thus, if the evidence is substantiated by further study, regular marijuana use during adolescence, but not adulthood, may permanently impair cognition [thinking] and increase the risk for psychiatric diseases, such as schizophrenia. In more technical language, the research study can be summarized as follows:

"NIDA-supported researchers at the University of Maryland School of Medicine have found further evidence that marijuana exposure during adolescence, when prefrontal areas of the brain are still maturing, can produce long-lasting cognitive impairment. Cortical oscillations, or the rhythm of neural firing across brain areas, play a role in cognitive functions like attention, integrating sensory information, and working memory, and they are known to be reduced also in schizophrenia and other diseases. The adolescent brain’s unique sensitivity to being modified by cannabinoids [marijuana] has been indicated in other human and animal studies, although this is the first study to directly link adolescent exposure to abnormal electrophysiological activity in the adult brain.”

So, the takeaway for this piece of research is that marijuana use by adolescents may cause damage to thinking processes in the brain that may last into adulthood. Marijuana is not a benign drug! As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 08/05/2013.

Powerlessness in a Relationship with an Alcoholic or Drug Addict

"Lack of power that was our dilemma (Alcoholics Anonymous, Big Book, page 45)" is language that underlies the foundation for recovery from alcoholism and from addiction: "When we admit our powerlessness and our inability to manage our own lives, we open the door to recovery (NA Basic Text, Pages 19-20)." But what of powerlessness when an individual loves an alcoholic or an addict? Here is what Al-Ateen says about the effects of alcoholism on loved ones of the alcoholic:

"Unlike diabetes, alcoholism not only exists inside the body of the alcoholic, but is a disease of relationships as well. Many of the symptoms of alcoholism are in the behavior of the alcoholic. The people who are involved with the alcoholic react to his behavior. They try to control it, make up for it, or hide it. They often blame themselves for it and are hurt by it. Eventually they become emotionally disturbed themselves” (from Alateen – Hope for Children of Alcoholics, page 6).

Similarly, Nar-Anon's Step One is based on powerlessness over the addict: "... we are not responsible for the drug addiction. We did not cause it, we cannot control it, and we cannot cure it. If we do not learn how to cope with drug addiction, we will contribute to the disease."

Being in charge, in control, and self-sufficient, sounds like a good thing, but can, for the person in a close relationship with an addict or alcoholic, result in isolation, frustration, and mental turmoil and confusion. What we can learn in recovery in Al-Anon and Nar-Anon is a balanced understanding of what we can control, and what we cannot control, that is, what we are powerless over. Clearly we cannot control our significant other's behavior, including whether he/she drinks or drugs. What we learn is that we can control, with the help of others in recovery and our Higher Power, how we react to whatever it is that we cannot control. It is a great freedom to realize that we need not control anyone else, only our own thoughts, actions, and reactions.

As I have said often in my posts here, the Serenity Prayer offers sound guidance to the persons in a relationship with an alcoholic or addict: God, grant me the serenity to accept the things I cannot change--OTHER PEOPLE; grant me the courage to change the things I can --ME AND HOW I REACT TO OTHERS; and the wisdom to now the difference.

As always, comments are invited. www.alcoholdrugsos.com. Jan Edward Williams, 08/01/2013.