Once an Addict, Always an Addict: Time Does Not Cure Addiction

In 12 Step programs and addiction treatment centers it has been an accepted tenet that once an individual has crossed the line into addiction, that individual cannot return to problem-free, controlled use of the addictive substance. There has been research suggesting that the reason underlying this principle lies in either the addict's inherent brain circuitry related to impulsivity, setting him/her up to develop addiction once use of an addictive substance is initiated, or is a result of changes in brain chemistry related to impulsivity caused by chronic use of the addictive substance.

Presumably, if the addiction is due to changes in brain chemistry from use of the drug, then perhaps over time abstinent from the drug the brain can heal, with cessation of impulses to use the drug. In a recent study summarized in ScienceDaily, researchers have found that there are changes in the brain chemistry of cocaine addicts that persist after long term abstinence from use of the drug, resulting in ongoing elevation in impulsivity measures.

Thus, in the words of one of the researchers, "The knowledge that some neural changes associated with addiction persist despite long periods of abstinence is important because it supports clinical wisdom that recovery from addiction is a lifelong process...”

So, once an addict, always an addict: time does not cure addiction! As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 09/24/2013.

Do You Have a Gambling Problem in Addition to Your Drug or Alcohol Problem?

In a recent study published in ISRN Addiction and summarized here, researchers highlighted the issue of gambling addiction in persons with alcohol or other substance addiction. Researchers stated that gambling addiction is a hidden problem in individuals with drug or alcohol problems that is rarely addressed in 12 Step Programs and treatment centers. Between 10 and 20 percent of individuals with substance addiction have a gambling problem.

Here are some resources for gambling problems:

Gamblers Anonymous 
Gam-Anon
National Council on Problem GamblingNational Problem Gambling Helpline Network 800-522-4700

Quick Screen to Identify a Gambling Problem
1. You have often gambled longer than you had planned.2. You have often gambled until your last dollar was gone.3. Thoughts of gambling have caused you to lose sleep.4. You have used your income or savings to gamble while letting bills go unpaid.5. You have made repeated, unsuccessful attempts to stop gambling.6. You have broken the law or considered breaking the law to finance your gambling.7. You have borrowed money to finance your gambling.8. You have felt depressed or suicidal because of your gambling losses.9. You have been remorseful after gambling.10. You have gambled to get money to meet your financial obligations.

A “Yes” to any of these questions, means you should consider seeking assistance from a professional regarding this gambling behavior by calling the National Problem Gambling HelpLine Network (800.522.4700) toll free and confidential throughout the U.S.

My favorite tool to see if you have a problem with any addiction is this: Does your gambling cause a pattern of negative consequences in any significant area of your life, such as, finances, relationships, work, health?

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 09/21/2013.

Significance of Hangovers

A recent study summarized in ScienceDaily of September 12, 2013, to be published in the September issue of Alcoholism: Clinical and Experimental Research, sheds some light on hangovers and how they differ in drinkers as they age. The researchers looked at alcohol use in a pool of over 50,000 individuals ages 18 to 94, and found that the incidence of hangovers in binge drinkers was greater in younger drinkers and decreased in older binge drinkers.

There was no attempt in this study to to see if there is a connection between hangover incidence and development of alcoholism. However, prior research has found that individuals who develop alcoholism often do not experience the physical ill effects of excessive drinking such as hangovers. The suggestion is, therefore, that drinkers at a young age who do not have severe hangovers after drinking to excess are more at risk for alcoholism.

My own experience of almost 25 years of working with young adults aged 18 to 21 is that individuals with a history of alcoholism in a blood relative, such as a parent or grandparent, almost invariably will have an inherently high tolerance for alcohol, rarely get sick no matter how much they drink, and have mild hangovers. These individuals probably have a genetic predisposition to develop alcoholism and are at a four to six times greater risk to develop alcoholism.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 09/14/2013.

Recovery and Reality

I remember in my recovery from addiction, and have remarked about this before in this blog, wondering if there would come a time when my spiritual progress would be such that I would have "made it" and could ride off into the sunset of recovery with an internalized assurance that all is not only well in the present but would always be well in the future regardless of life's happenings. I guess that type of thinking is due at least in part to the Hollywood model or paradigm of life whereby the protagonist in life's drama would reach such an awesome state of spiritual progress that there would be a magnificent swelling of trumpets, violins, and cymbals, and  the scene would slowly fade into darkness with the message that the hero woud live a problem-free life forever after.

Alas, recovery from addiction, no matter the duration or the spiritual progress, does not follow the traditional Hollywood model, and realities and problems do happen, followed by human reactions to them that are driven by self-centered emotions and thinking errors, such as fear, self-pity, plus accompanying physical and emotional pain. The cause for this reflection is my recent injury resulting in a broken ankle and disruption of my seemingly ordered world--I am now in a wheelchair, cannot drive, work, or do much of anything for a while.

But, hold on a minute! After some prayer and meditation, support from my wife and good friends in recovery, I am quickly back into a mindset in which I can truthfully say: "Fundamentally all is well." The reality of my life at this moment has not changed but my reaction to that reality has. Indeed, on further reflection, the spiritual tools of recovery  can and do offer a "Hollywood ending" except that the ending is really a series of spiritual adjustments to life's realities using recovery tools. Before finding a spiritual way out of addiction, I was controlled by life's problems and my self-centered and self-defeating reactions to them. Now, though it may take some time, I have the spiritual tools to be OK in the midst of reality problems.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 09/07/2013.

With Seconds to Live, Will Your Addiction Have the Last Word?

In a brief article in livescience, the question is raised as to whether a few seconds of consciousness remain in an individual after decapitation. The article's author referred to some data supporting ongoing brain activity after decapitation: “In 2011, Dutch scientists hooked an EEG (electroencephalography) machine to the brains of mice fated to decapitation. The results showed continued electrical activity in the severed brains, remaining at frequencies indicating conscious activity for nearly four seconds.”

This article reminded me of a humorous story my first recovery mentor (sponsor) used to tell to illustrate the relentless power of denial in addiction. He would say: “I understand that after the heart stops beating, there remain a few moments of consciousness, during which I am sure my head would say, “Now, Norb, (his name) Now, you can drink!”

As always, comments are invited. 09/01/2013. Jan Edward Williams, www.alcoholdrugsos.com.

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.