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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
No matter what your road to recovery looks like, Dummies is on your side Addiction and Recovery For Dummies gives you the tools you need to identify and face addiction in yourself or a loved one, while working towards a healthy and realistic approach to recovery. This book offers a compassionate, unbiased, and non-judgmental guide to evaluating and overcoming addiction. You'll learn to identify the range of addiction levels, the various types (including substance and non-substance), and the possible causes of addiction. An expert author guides you through the range of addiction treatment philosophies and approaches, including twelve-step programs, other in- and outpatient programs, and teen treatments. We'll also look at common recovery roadblocks, so you're prepared to overcome whatever hurdles your recovery process brings. Medications, therapeutic communities, self-help groups, long-term recovery strategies--it's all in here. * Learn the signs of addiction and identify the most appropriate treatments * Gain advice on offering help to friends or family members struggling with addiction * Discover available recovery supports, including groups and medications * Understand the media and cultural factors that encourage addiction, and how to avoid them Updated with the latest treatment options, Addiction & Recovery For Dummies is a valuable resource for those on a recovery journey, and a support guide for the 45 million people who are directly impacted by addiction.
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Addiction & Recovery For Dummies®, 2nd Edition
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ISBN 978-1-119-88699-0 (pbk); ISBN 978-1-119-88700-3 (ebk); 978-1-119-88701-0 (ebk)
Addiction & Recovery For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Addiction & Recovery For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: The Hole in the Heart: Detecting Addiction
Chapter 1: Addiction: What Is It?
Defining Substance Use, Abuse, and Addiction
The Role of Experimentation
Assessing Your Addiction Risk
Exploring Methods and Models of Treatment
The Ins and Outs of Recovery
Chapter 2: Substance Use, Substance Abuse, and Addiction
The Basics of How Substances of Abuse Work
The Drug Lineup
Chapter 3: Behavioral Addictions: Addictions Without Substances
Some General Advice
Compulsive Gambling
Sex and Pornography
Computer Games and the Internet
Food Addiction
Work Addiction
Chapter 4: Dancing with the Tiger: The Risks of Experimenting
Going with the Flow: Peer Pressure and Other Influences
The Risks of Experimentation and Addiction
The Costs of Addiction to Families
Part 2: Taking Those First Steps
Chapter 5: Recognizing Addiction in Yourself and Others
Am I at Risk?
Genetics: Addiction Across Generations
How a Body Gets Addicted
Waking Up to Your Own Addiction
Perceiving Addiction in a Loved One
Chapter 6: Assessing Your Readiness: Do You Need Help Now?
Understanding Your Role as the Client
Assessing the Options
Matching Your Characteristics to Treatment Options
Deciding When to Start
Chapter 7: Quitting: Easy to Say, Hard to Do
Successful Quitting
Becoming Aware of Your Triggers
Increasing Your Motivation to Change
Factors That Affect Your Ability to Find Addiction Freedom
Part 3: Examining Treatment Approaches
Chapter 8: Treatment Choices
Different Viewpoints on Addiction
Combination Treatments
Chapter 9: Reviewing Inpatient and Outpatient Treatment Options
Interventions: Breaking Through Denial and Fear
Residential Versus Outpatient Care: Deciding What’s Best for You
Outpatient Treatment
Residential or Inpatient Treatment
Relapse Prevention
Therapeutic Communities and Sober Living
Andrew’s Choice: A True Story of Getting into Treatment and Achieving Success
Chapter 10: Treating Physical Dependence
Understanding Your Body’s Reactions to Drugs
Detoxification: What Is It, and How Does It Work?
Knowing What to Expect with Detoxification Treatments
Medications That May Help
Methadone Treatment
Chapter 11: Twelve-Step Programs
Types of Twelve-Step Programs
The Actual Twelve Steps
Working Your Program
Deciding Whether a Twelve-Step Program Is Right for You
Problems with Twelve-Step Programs
Chapter 12: Joining Self-Help and Support Groups
Secular Organizations for Sobriety and Save Our Selves (SOS)
Self-Management and Recovery Training: SMART
Women for Sobriety (WFS)
Religious Organizations
Chapter 13: Psychedelic Therapies and Other Alternative Treatments
Psychedelics
Acupuncture
Ibogaine
Ketamine
Nutritional Therapy
Meditation
Harm-Reduction Approaches
Chapter 14: Teen Treatment
Why Alcohol and Drugs Are More Destructive When You’re Young
What to Do When You Suspect Substance Abuse in a Loved One
Getting Treatment as a Teen
Remembering That Slips Aren’t Freefalls
Part 4: Life in Recovery
Chapter 15: Overcoming Barriers to Recovery
Be Prepared: The First Step
Building Your Skills for Recovery
Pacing: Taking Things One Step at a Time
Building Resilience
Handling Your Everyday Fears
Handling Your Fears about Recovery
Avoiding Self-Anger: A Slippery Slope to Relapse
Taking Action: Storming the Barricades
Chapter 16: Handling Slips and Relapse
Slips Versus Relapse: What’s the Difference?
Why Relapse Happens
Learning from Relapse
Getting Your Balance Back
Chapter 17: Handling Work and Family During Recovery
Dealing with Relationships During Recovery
Dealing with Family Problems
Dealing with Work Problems
Dealing with Financial Problems
Relapses, Restarts, and How They Affect Your Family
Chapter 18: For Families and Friends: Ways to Make a Difference
Breaking Through Denial and Codependency
Preparing for Change
Helping Your Loved One Follow Through
Supporting Change over the Long-Term
The Ups and Downs of Change
Sustaining Optimism and Support in Your Family
Part 5: The Part of Tens
Chapter 19: Ten Ways to Help a Friend or Loved One
Talk Things Over Truthfully While You Listen Attentively
Recognize the Telltale Signs of Addiction
Confront Denial
Help Get Treatment
Let Go of Your Need to Control the Situation
Hold Criticism at Bay
Offer Balanced Support
Understand What You’re Fighting
Remain Optimistic
Know What to Do When Treatment Efforts Fail
Chapter 20: More Than Ten Self-Help Resources
Self-Help Books for Problems Related to Addictions
Self-Help Websites for Managing Addictions
Websites for Treatment Models
Websites for Families and Teens
Websites for Problems Related to Addictions
Online Lectures on Addiction-Related Topics
Treatment Centers
Index
About the Author
Connect with Dummies
End User License Agreement
List of Tables
Chapter 3
TABLE 3-1 Work Addiction Checklist
Chapter 4
TABLE 4-1 Anger Assessment
Chapter 5
TABLE 5-1 Neurotransmitters and Their Triggers
TABLE 5-2 Percentage of People Who Become Dependent on a Drug after a Period of ...
Chapter 6
TABLE 6-1 Risk of Substance Abuse Addiction in People with a Psychiatric (Mental...
TABLE 6-2 List of Problems Clients Have Reported at the Time They Entered An Add...
TABLE 6-3 Cost-Benefit Analysis of Seeking Treatment
Chapter 10
TABLE 10-1 Lengths of Time for Withdrawal Symptoms to Cease Following Cessation ...
Guide
Cover
Title Page
Copyright
Table of Contents
Begin Reading
Index
About the Author
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Introduction
You’ve likely picked up this book because of addiction troubles, either your own or those of someone you care about. It’s immediately important to know that no one is singly responsible for these troubles. We live in an addiction-inducing society. A lot of money is made from addictions. When more people become addicted, more money is made. Despite this, addictions are more treatable now, and the scientific support for such treatments and for what you can do for yourself or for a loved one is more powerful and reliable than ever before.
You may often hear people say that they’re battling an addiction. Addiction is a life and death battle. There’s no compromise with addiction. People with addictions are either becoming less addicted or getting more addicted. But there is another analogy to consider: a journey through life where loving people support those with addiction in finding a natural life-path — a path that is increasingly free of addictions.
First, it’s important to destigmatize addiction. Addiction is unfortunately associated with technological progress. As technology progresses, newly developed substances powerfully target pleasure centers in the brain, mostly to ease the pain in those severely ill. As a result, substances have been created that are more accessible, tempting, and frequently used than before. With more technological development, addictive behaviors may increase during the 21st century, and they’ve already reached alarming levels. Therefore, we scientists, caregivers, and people with addictions must work together to use evidence-based methods to free ourselves from the powerful effects of society, technology, marketing, and the very human drive to consume.
Second, it is important to remember that recovery is an inner journey, and people with addiction often feel alone. In their aloneness, they ache and yearn for healthier states of mind and body. To recover, people with addiction must find inner strength, and often need help in doing so. This book can help those with addiction rediscover and feed inner strengths and recover — so they can reclaim the joys of life as healthy human beings.
About This Book
This book is written for two audiences. It is first and foremost written for people seeking freedom from addiction. You may still be deciding whether you need help and whether you really want to be free from your addiction. You may have already tried to overcome addiction and failed (perhaps many times). But now you can effectively do it. Yes, you can.
In this book, I inform you of all the effective available options. This book addresses them in language you can understand and with references that take you to the scientific core of reliable knowledge. It helps you determine how big a problem your addictive behavior is. It helps you assess your readiness for treatment and which treatment you’re ready for. It describes all the evidence-based professional and self-help treatment approaches including:
Pharmacotherapies and detoxification treatments
Psychological outpatient treatments and residential treatments
Different types of self-help and their likelihood of truly helping
Treatment programs based on the Alcoholics Anonymous twelve-step model
This book is also written for family and friends of addicted people. In my experience, the family is often first to seek help for a loved one’s addiction. This book guides family members in considering treatment options. It provides information and direction on how to communicate with the family member whose addiction worries you. It also provides support and guidance in helping family members ensure their own needs are not neglected despite the desperate needs of the addicted relative.
The book includes specific information for teens and adults, and addresses substance addictions (such as drugs and alcohol) and behavioral addictions (such as gambling and sex). It is organized into five parts and 20 chapters. Chapter titles and chapter subheadings let you know who the particular chapter or section is addressing. I use a minimum of professional and medical jargon. When jargon or medical terminology is used, I highlight and define the terms and mark them as technical stuff.
I incorporate many case studies of individuals as illustrations. The identities of these people are carefully disguised to protect confidentiality. In many instances, an individual’s story represents a composite of experiences with multiple clients. When these case examples are used to embellish a point and aren’t central to the information or guidance discussed, the story is highlighted in a sidebar. Sometimes the case examples are part of a point I’m trying to make. In those cases, you find them in the regular body text. You should consider the sidebars as extra material that you don’t have to read if you don’t want to.
There is no need to read the chapters in order — instead, start with the chapter that is of most interest to you at the moment. Nor do you need to read the entire book. This is a reference guide on how to recover successfully. You need only refer to the chapters relevant to your needs. But of course, if you want to read the whole book cover to cover, that’s best!
Accordingly, start with the chapter(s) of most interest. Most chapters assume that the primary audience is the person struggling with an addiction. However, some chapters are specifically written for the families of addicted persons.
Foolish Assumptions
I assume that if you are still reading this introduction, you are struggling with an addiction yourself and want to learn more about how to be free from your addiction, or you are a family member or friend of an addicted person and are searching for help. If either of these descriptions fits, this book is written for you.
Icons Used in This Book
Throughout this book, I use icons in the margins to quickly identify different types of information. Here are the icons I use and a brief description of their meaning:
As the name implies, the Tip icon alerts you to pieces of practical information or things you can do to handle your addiction problem.
The Remember icon highlights information I don’t want you to forget.
The Technical Stuff icon is used to indicate that the information in the paragraph is of a technical nature, and you need not read it unless you want to find out more about the professional and scientific aspects of addictions.
The Warning icon alerts you to things you should avoid. It is also used to highlight cautionary points about addictions.
This icon highlights case studies of individuals experiencing addiction, either themselves or when helping a loved one. These case studies are often set as sidebars to the main text.
Beyond the Book
For some helpful information about how to recognize addiction in yourself or a loved one and some practical approaches to treatment and recovery, check out the Cheat Sheet for this book by visiting www.dummies.com and entering the book’s title in the search field.
Where to Go from Here
You are not alone in what you’re confronting. A lot of people are facing the same problems right now. You don’t deserve to be stigmatized in any way. We are currently experiencing a pandemic of addiction. Whether you accept one or another of the evidence-based theories about why this is true, your main concern is, and should be, to get healthier and less inclined to sip, inject, smoke, and otherwise ingest poison.
That is much easier said than done.
My writing of this book humbly reflects the gap between being informed and doing what you know is “right.” Whatever you do — whether it’s during the next five minutes, five days, or five months — that’s the hard part. When you read, please know that all that’s written humbly acknowledges the hard part.
Not only can addiction or dependence on a substance or a behavior (which seemed harmless) ruin life, we live in an indulgent time where too many try to take the “easy way out.” There’s no easy way out of addiction, nor toward healthy states of mind and body. Yet it doesn’t have to be purposely hard to get healthy, and part of the difficulty is selecting the steps by which meaningful progress is accomplished. That is what this book is about — to find and do the next step of leaving addiction behind, and welcoming health.
You can go straight to whatever chapter is of most interest to you right now. If you’re seriously considering treatment, I suggest you review Part 3 to get informed about the treatment options available to you. I also want to draw your attention to Chapter 7, because it helps you get a full understanding of the factors you must address to free yourself from your addiction.
Now, to get started. Against great odds, humans succeed with great achievements. You can recover, and with the help outlined in this book, I will help as much as I can.
Part 1
The Hole in the Heart: Detecting Addiction
IN THIS PART …
I help you detect the signs of addiction and determine whether you or someone else is addicted. I provide surprising facts about how common addiction is and about the many forms it takes. I especially focus on substance addictions (such as drugs and alcohol) and behavioral addictions (such as gambling, sex, and eating).
One of the challenges is knowing whether your use of a substance or reliance on a behavior is a problem. In this part, I explain the differences among use, abuse, and dependence. I also discuss how costly addictions are — to you personally and to your family.
Chapter 1
Addiction: What Is It?
IN THIS CHAPTER
Looking at use, abuse, and addiction
Understanding your personal risk of addiction
Reviewing treatment options
Stepping onto the road to recovery
Congratulations on picking up this book and leafing through it. Even if you just read these few words (and no further), remember that you are on a path. Just by choosing to pick up this book means you are seeking to find a nonaddictive path for yourself or for someone you love. It could be a path that will lead to a rediscovery of your inner strength and inner peace.
Yes, you have probably had highs that feel so good it’s hard to describe them. But they are not sustainable in the way you elicited them. You have to find a nonaddictive path to getting high and find a gratifying way of living. You may think you have already found one and that all you have to do is tone things down a bit. But it’s hard to “tone down” a poisoning — poisons destroy in both small doses and in large doses. Addiction is the poison of everyday life in the 21st century. Why is that true?
Addiction robs you of freedom and control. You may think you choose to use and can choose to use less — but just try to stop. See if it’s possible. See whether you have control over the addictive substance or behavior you’re afflicted with. If you find you do, great. Abstain for a while. Be sure you have the control you think you have. If you don’t have control, if abstaining is unthinkable or impossible, read on.
In this chapter, I tell you about the different forms of addictions, emphasizing substance addictions and behavioral addictions. I tell you about how the medical community views addiction and how your personal view, when it’s all said and done, is what you’ll likely follow. I also provide a brief overview of what the rest of this book provides.
I designed this book to help you understand where you are, right now, in your control over addictions. This understanding can help you find your path to freedom and well-being, and resume true control of your life.
Defining Substance Use, Abuse, and Addiction
You may hear a number of addiction-related terms and it can be confusing as to what exactly they mean. The less confusion around these terms, the better. The clearer your understanding, the more you know about how to get and make use of the help available.
Understanding what addiction is
In 1964, the World Health Organization (WHO) suggested replacing the term addiction with the word dependence for describing the feeling that, mentally and physically, you must use a substance. Your brain and body yearn for it!
In this book, addiction refers to a combined mental-physical dependence where you’re irresistibly compelled to use a substance or behave a certain way. Using the substance or engaging in that behavior is so compelling that even knowing you may face considerable harm does not stop you from doing it.
You’re addicted when you no longer direct yourself out of harm’s way. You’re addicted when you use substances or engage in behaviors that put you in harm’s way.
Simply put, addiction causes a fundamental change in your brain. A change that scientists and clinicians are trying hard to understand. But even though this change is mysterious and powerful, when it occurs, certain urges become irresistible. You become so compelled that nothing else matters. It doesn’t matter how smart you are, how accomplished, or how physically strong. It’s well proven that addiction can happen to virtually anyone.
Mental dependence
Mental dependence refers to associations that develop in your mind between events (called triggers) and emotional and physical urges to use the substance or do the behavior. The triggers are memory traces that are, in turn, set off by other stimuli. They exert a powerful influence on behavior. Moreover, they’re not just in your mind — through a series of chain reactions, they induce biochemical changes throughout the body.
What is the difference between mental and physical dependence when both cause fundamental chemical changes? The main difference is that the chemical changes brought on by mental dependence are due to mental associations. Simply put, just thinking about getting high changes your chemistry and affects your whole body biochemically so that physical excitement is felt and is compelling.
Physical dependence
Physical dependence, on the other hand, doesn’t require any thinking at all. It’s simply related to the physical addictive effects on multiple brain chemicals called neurotransmitters. The brain adjusts and tries to tolerate the drug. Then you don’t feel “normal” or “good” unless you take the substance. Physical dependence describes your brain’s physical adaptation.
As explained in Chapter 10, you can detoxify your brain (get rid of poisonous chemicals). You can clear out a physical dependence relatively quickly (several days). However, your mental dependence can last a lifetime. Much of this book is about reducing mental dependence. My goal is to help you direct yourself away from the disaster and cause the mental imprint to fade. If you are successful, the imprint fades so completely that you may wonder why you didn’t start a new and better life sooner.
For more of the differences between mental and physical dependence, see Chapter 5.
The difference between abuse and dependence
The difference between abuse and dependence is a matter of time and degree. Essentially, dependence is associated with tolerance (you need more and more substance to feel the same high) and withdrawal symptoms (you experience substance-specific withdrawal symptoms when you stop using), and abuse is associated with a single or continued substance use despite harmful health, social, and financial consequences. The medical criteria for substance dependence and substance abuse are summarized in the following sections.
Medical criteria for substance dependence
From the medical perspective, dependence is defined as experiencing at least three of the following criteria within a 12-month period:
You experience tolerance to the substance, which is defined as a need for markedly increased amounts to achieve the desired effect, or there’s a markedly diminished effect with continued use of the same amount.
You experience withdrawal, as evidenced by a withdrawal syndrome for the substance or when medications, prescribed to relieve withdrawal symptoms, are discontinued.
You’ve taken the substance in larger amounts or over a longer duration than initially intended.
You’ve made unsuccessful attempts to cut down or control substance use.
A great deal of time in activities is spent obtaining the substance (preoccupation with how and when you will get your next fix).
You neglect or abandon important social, occupational, or recreational activities because of use.
Your substance use continues despite knowledge that there are persistent or recurrent problems related to your use.
Medical criteria for substance abuse
The medical definition of abuse is experiencing one or more of the following criteria within a 12-month period:
Your recurrent use of the substance results in a failure to fulfill major role obligations at work, home, or school.
You use the substance in situations where it’s physically hazardous (for instance, while driving a car).
You have recurrent substance-related legal problems.
You continue to use the substance despite persistent or recurrent social or interpersonal problems caused or worsened by use (for instance, arguments with your spouse about the consequences of your use).
Nonsubstance or behavioral addictions
Nonsubstance or behavioral addictions are behaviors you engage in that meet many of the same criteria as substance addictions. The behaviors dominate your life: You feel compelled to do them. Examples are pathological gambling and sex addiction.
When the medical criteria outlined in the preceding two sections are applied to behavioral addictions, the definitions become less clear. You can readily see how a behavioral addiction meets criteria for abuse (such as pathological gambling), but the dependence criteria don’t apply as readily with addictions like workaholism, overeating, and excessive sex. Still, tolerance builds up with behavioral addictions. You need to do more and more of the activity or engage in more and more risk in relation to the activity to get the same high. (For more on behavioral addictions, see Chapter 3.)
Your personal definition of addiction
Regardless of all criteria, you know if you have a substance or behavioral addiction. You know it because the actions involved in getting the substance or doing the behavior dominate your life. You may not want to reveal what you know to anyone else, but it’s difficult or impossible to hide it from yourself.
Sometimes the line between heavy use and abuse or dependence gets fuzzy. The case examples of Joe and Mark in the following sections may help you find more clarity about yourself.
Case study: Is Joe abusing marijuana?
Joe smoked marijuana every day — his first joint was in the morning. Smoking was his way of approaching the day in a mellow frame of mind. Joe was in his third year of college; he’d started smoking marijuana at the end of his sophomore year. He enjoyed college and felt in no hurry to finish, partly because he was still uncertain about what he wanted to do after college. At least, this is how he rationalized taking half the course load he should have been taking in his third year. At this rate, it would take him twice the normal time to complete college.
Joe supplemented his income from a student loan by working as an assistant in the college library on Saturdays and Sundays. He tried getting other jobs, but found that the hours of work conflicted too much with his recreation time. Other than paying for a steady supply of marijuana, he figured he had few financial needs. The student loan paid for tuition and rent. He even had money left over to sustain a pretty simple diet of bread, peanut butter, jam, and an occasional hamburger. The money he made at his part-time job on the weekends financed his drug habit.
Joe was a bit of a loner. He only had a few friends to get together with on Saturday nights. They often went to a bar to play pool and drink beer, and, of course, smoke a joint or two. During the weekday evenings Joe kept to himself. He rented a room in a house near campus. The other rooms were also rented out to students, but Joe didn’t socialize with roommates. What he most liked to do in the evenings was smoke marijuana and listen to music. He rarely got to bed before 2 a.m.
Is Joe abusing marijuana?
Case study: Is Mark abusing marijuana?
Mark’s situation was very similar to Joe’s. Like Joe, Mark smoked marijuana daily, and Mark was also at college. However, unlike Joe, Mark was very outgoing and sociable. He started smoking marijuana at parties (he met his girlfriend at one party). He and his friends usually socialized as a group, sometimes partying at the local dance club and sometimes getting together at fraternity houses. Mark lived at home, so he seldom had the opportunity to host these parties himself. He worked on the weekends, but because his living expenses were low, he could use most of his earnings to buy marijuana.
By his third year, smoking marijuana had become a daily habit. Mark’s room was in the basement of his parent’s house and so he could sometimes smoke at home without being detected. However, most of the time, he had a few joints in the evenings when he went out with his buddies.
His girlfriend sometimes joined in, but increasingly she complained that she was tired of the parties. They had been fighting a lot lately because she wanted them to branch out and do a variety of activities. Mark didn’t want to fight, but he also didn’t want to cut back on seeing his buddies and smoking marijuana.
Mark started to experience problems at college in his third year. He rarely got home before 1 a.m., so getting up in the morning became a big problem. He couldn’t keep up with a full course load and dropped two classes. He kept his afternoon courses, reasoning that they were scheduled at a more reasonable time of the day. It wasn’t long before his parents noticed the major shift in his sleeping pattern. Arguments became increasingly frequent between Mark and his parents, who complained that he wasn’t taking his studies seriously. He complained that they were old fashioned.
Is Mark abusing marijuana?
The answer
Both Joe and Mark are abusing marijuana. Because Joe is a loner by nature while Mark has a sociable personality, and because Joe’s lifestyle is so closely aligned with his drug habit, the problems he’s having with marijuana use may seem less obvious. Nevertheless, both men are abusing marijuana. In both cases, marijuana use has interfered with school and occupational activities. The adverse consequences are more apparent in Mark’s case because his drug use is causing problems with girlfriend and family. Although his parents may not yet know the underlying cause of the shift in his schedule, they have picked up on the problems he’s having with meeting school responsibilities. Thus, Mark’s drug use may appear more obvious because it’s affecting many areas of his life. However, in actuality, both men’s drug use meets criteria for substance abuse. In both cases, marijuana use is interfering with them fulfilling their school and occupational responsibilities.
You only need to have one of the medical criteria for substance abuse to be diagnosed as having a substance abuse problem.
The line between use and abuse can become blurred because of the gradual nature of addiction. It’s very easy for you to rationalize substance abuse as normal. The first step toward freedom from addiction, however, consists of taking an honest look at how the substance use is affecting your life.
The Role of Experimentation
Drug use typically begins with experimentation. (“Hey, try this. It will make you feel so good!”) When young, saying no is hard. It may seem okay to experiment, but make it a truthful experiment. Ask yourself how you truly felt after your experimentation.
All people with an addiction started by experimenting. No one sets out thinking about becoming addicted. However, substance use affects brain chemistry beyond your ability to detect. You don’t realize your brain is changing just as you may not realize that your liver is changing. Before long, experimentation becomes dependence. After a while, dependence becomes addiction.
Assessing Your Addiction Risk
The first step toward getting help is recognizing the problem. Part 2 of this book focuses on recognizing and assessing your addiction risk and what parents and friends can look out for. It also discusses many social influences that may influence you to experiment with substances and behaviors. (See Chapter 4 for information on the social influences.) Knowing what may have led to your addiction problem can help you avoid relapse following treatment. If your use hasn’t progressed to abuse and dependence, this information can help you avoid developing a prolonged problem.
Warning signs of addiction
The defining sign of addiction is that you feel compelled to use a certain substance or do a certain activity. In Chapter 5, I provide a tool that assists you in assessing the likelihood you’re addicted. I also discuss the risk factors for developing an addiction problem. Following are some factors you need to be aware of:
Your family history:
The attitudes, behaviors, and genetic vulnerabilities you inherit and pick up from your family render you more or less susceptible to developing an addiction problem.
Your willingness to experiment with risky behaviors:
If you’re a risk-taker by nature, you’re more likely to experiment with drugs. Experimentation is always the first step and it may be a slippery step.
Your mental states:
If you have problems controlling negative mood states like anxiety, depression, and anger, you’re more likely to use substances (for instance, alcohol) or addictive behaviors (for instance, overeating) to regulate moods.
Your choice of drugs:
Some drugs are more addictive than others. (Check out the addictive potential of different substances in
Chapter 5
.)
A comment for families and friends of the addicted person
Families can often sense that something is wrong without knowing the specifics of the problem. In Chapter 5, I provide an assessment tool that helps family members and friends determine whether a loved one is battling an addiction. Uncharacteristic and negative changes in moods and social habits are important clues. But ultimately, the only way of getting to the bottom of the problem is to have a sincere talk with your loved one.
Be careful not to enable your loved one’s addiction. Family members want to protect the addicted person and reduce potential harm. This may take the form of bailing your loved one out of jail, offering housing, or ensuring proper nutrition. All these actions, although they reduce the immediate harm, can enable continued substance abuse. Helping your addicted relative prevents the person from hitting bottom. Harm reduction efforts are important, especially when addiction treatments have repeatedly failed. However, be mindful of the fact that your good intentions may be contributing to continued addiction behavior. Get good advice from professionals about how to best handle addiction in a friend or family member. In Part 2 of this book, I talk about addiction treatment options. In Chapter 18, I provide specific information for family members and friends.
Look after your own needs. A friend’s or family member’s addiction problem can quickly dominate the lives of other people like you. Moreover, family members and friends can quickly become discouraged by the repeated failures in efforts to stop the addiction. Thus, you need to look after your own needs. In Chapter 18, I provide information on how to protect your own welfare when battling the consequences of a friend or relative’s addiction.
Exploring Methods and Models of Treatment
Do I have an addiction problem? Am I ready for treatment? Do I need to be hospitalized to safely withdraw from a substance addiction? After I’ve kicked the physical dependence on the substance, can I kick the mental addiction on my own? What are my treatment options? Who typically undergoes this or that type of treatment? What treatment options are available on an outpatient basis and which involve residential stays? What are some of the myths about overcoming an addiction? When are self-help treatment approaches helpful?
These and other questions are addressed in Part 3 of this book. Fortunately, a wide range of treatment methods and models are available to assist you. A few of these are previewed in the following sections.
Treatment centers and professional help
Shame and stigmatization about the addiction is the major barrier to seeking professional help. Most likely, you’ve tried to quit and even sought advice from trusted advisers (friends, family doctor, minister, priest, or rabbi) before seeking professional help. Unfortunately, many advisers don’t have enough knowledge or resources to help you withdraw. Nor can they provide treatment for the mental aspects of addictions. However, they’re often a good resource for learning about specific addiction treatment options in your community.
In some situations, you may not be seeking help on your own. Rather, it’s your family or employer who is confronting you with treatment options. Thus, your initial exposure to treatment may not have been the treatment of your choice.
You must want to change to successfully recover. No amount of external persuasion will help overcome an addiction if you don’t want to change. After you do get to the point of seriously engaging with treatment, seek out the treatments most suited to your needs.
Things to consider when deciding on your treatment
Many treatment options are available to you. What you choose depends on a number of factors:
Can you afford the time and money it takes to go into a residential treatment facility? Most require a minimum stay of 28 days. Can you afford not to?
Residential treatment centers offer some advantages over outpatient programs. They get you away from many of the social and environmental triggers for your addiction. You’re exposed to treatment information from the professional staff and from peers within the center. Your peers can share their firsthand experiences about what has and hasn’t helped them, and they can be an unconditional source of support.
Overcoming addiction is often easier than staying substance- or behavior-free over the long-term. Relapse rates are alarmingly high. The mental aspects of addictions are harder to treat than the physical dependence. Addictions affect every aspect of life and triggers are hidden deep within your family and social environments. Therefore, consider a variety of options for help.
When it comes to treating addictions, take a variety of approaches. Most treatment options allow you the freedom to combine different approaches.
Abstinence is usually the goal of treatment. In some cases controlled use is possible.
Chapter 9
provides information on controlled drinking approaches.
If you are physically dependent on a substance like alcohol, controlled use is not an option for you. Your treatment goal must be abstinence.
The twelve-step program and other self-help approaches
Almost everyone has heard of the twelve-step program of Alcoholics Anonymous (AA), but you may not know everything about what twelve-step programs involve. The AA twelve-step program is perhaps the most common treatment model for overcoming addictions. Although it started as a peer-support treatment program for alcohol addiction, it has rapidly proliferated as a treatment for both substance and nonsubstance addictions. You can find an AA program in virtually every community. Many AA groups address multiple types of addictions, so you may not need to find a specific group for your particular addiction. I devote a whole chapter (Chapter 11) to describing the twelve-step program. I also include a self-assessment tool to help you determine whether the AA twelve-step treatment approach is likely to work for you.
Self-help approaches generally aren’t sufficient to help you overcome addiction. You may well need to start with a residential treatment approach early in your recovery program. You can also consider combining various treatment approaches. Because addictions affect every area of your life, you may also need psychotherapeutic approaches to help you unravel the emotional and social aspects of your addiction problem. Chapter 8 provides information on some of the psychotherapy approaches to treating addictions.
The Ins and Outs of Recovery
As you begin the journey of recovery (whether it is the first time or the umpteenth time), I hope that this book will help you find the means to free yourself from addictions.
The treatment of addictions involves both getting clean and restoring a normal way of living. Therefore, recovery means not just abstinence from the addiction, but also repairing the damages that the addiction has brought to your life and addressing some of the vulnerabilities in your emotional makeup and social background that rendered you susceptible to addictions. Effective recovery, therefore, also means building awareness and strategies to resist your triggers. In Part 4 of this book, I focus on these recovery topics.
Overcoming fears and obstacles to recovery
What does it mean to enter treatment? What will your friends and colleagues think? How will you cope with the loss of comfort you associate with the addiction? You need to be aware that your anxiety, shame, anticipated loss, and other issues will act as barriers to getting help for your addiction. Chapter 15 provides guidance to you in overcoming these barriers to change.
Remember that solutions you use to deal with your addiction will also need to address the specific issues in your social and psychological environments that present barriers to successful recovery.
What to do if you slip
You need to know that recovery is a work in progress. As you repair and rebuild your life after an addiction, you will come face-to-face with temptations and triggers to slip back. You may slip off the wagon once, twice, thrice, or more, but slips are just temporary lapses in your recovery process. Look for what you can learn from the situation. For example, a longer passage of time of abstinence between slips is positive feedback. Thus, learning about your triggers (when you feel down, for example) can help you plan how to handle the same situation (trigger) more effectively next time. Chapter 16 provides specific guidance in handling slips and relapses.
How to relate to family, friends, and colleagues
By the time you find yourself in treatment for an addiction, a lot of hurtful things have probably been said and done by you to your family as well as by your family to you. If these relationships can be mended, your recovery may proceed more effectively. Therefore, I encourage you and your family and friends to consider actively participating in the forgiveness process. Chapter 17 deals with handling these relationships in recovery.
Recovery can also be a time for the start of new relationships. You’ve seen the damage that addictions can do to intimate relationships. You may feel anxious about when to trust yourself enough to start a new relationship. You may have questions about how much to disclose to new friends. These and related issues are addressed in Chapter 17.
Many successfully recovered people liken their process to a rebirth. It’s normal and natural for you to seek new friends and relationships. Frequently, you may connect with others you meet in peer group therapy settings.
What family and friends can do
Addiction isn’t just the problem of the person battling addiction. The personal problems cause collateral damage to family, friends, and colleagues. Thus, many sections of this book provide tips for friends and family. Chapter 18 focuses specifically on guidance for families and friends.
Chapter 2
Substance Use, Substance Abuse, and Addiction
IN THIS CHAPTER
Discovering how addiction works
Looking at different types of substances and their effects
Substance use is part of our heritage. Humans have experimented with mind-altering substances throughout recorded history. As far back as the 6th century Bc, a Persian king was identified as an alcohol-abuser. In this chapter, I discuss current substances of abuse — those that people use to alter their minds. First, I go over the basics of how drugs and alcohol destabilize and disrupt the body. Then, I present an in-depth list that covers most of the substances abused today that can be tempting, confusing, and destructive.
The Basics of How Substances of Abuse Work
Substances consist of molecules — the smallest analyzable unit — and these molecules affect your brain as active ingredients (which readily cross the blood/brain barrier) or buffers (chemicals that neutralize or reverse active drug effects) or fillers (chemicals with little apparent effect). While the active ingredients of most drugs and types of alcohol are relatively well-known, what’s less known is how they combine over time to leave a detectable imprint in the brain and body. This imprint consists of a complex set of neurophysiological events that render your mind and body beyond your control. This imprint also helps in understanding cross-addictions, where people successfully cease abusing one drug to fall into abusing another. While this is discouraging, an understanding of cross-addiction helps limit and destigmatize abuse. Let’s take a closer look.
In an initial addiction or dependency imprint, a need develops in the brain for an external stimulus (a chemical or behavior) required to operate normally. This perceived need (or addictive imprint) fades with withdrawal, but enough remains so that perceived “needs” are often transferred, optimally to a less toxic substance (coffee) or behavior (jogging). However, the imprint remains and can rapidly become a “slippery slope” when even minor instabilities in lifestyle result in recurrent addictions (or dependencies).
I’m not suggesting the imprint never fades, but it fades incrementally and remains surprisingly strong for years later. I’ve seen successful individuals attend a smoking cessation program and describe a 40-year period of abstinence. Then, they decide to try one more cigarette and return to a two-packs-per-day addiction.
The imprint created can be explained by the active ingredients in drugs and alcohol (and behaviors) that are psychoactive, meaning they influence mental activities like thinking, memory, and the processing of sensation. Psychoactive reactivities also affect breathing and the beating of our hearts. The body is so sensitive and so dynamic that we can assume that when we consume a substance, be it health-inducing or toxic, we’re changing our brains in one way or another. While psychoactive substances frequently exert mildly psychotoxic effects, it’s a matter of dose, timing, and combination. The same substance taken during a depressive episode in combination with other noxious substances can be fatal.
Addiction occurs when, due to tolerance, you need more of a drug or behavioral engagement to get high (or equally high) and you suffer withdrawal when the blood levels in your body drop. Add these biochemical changes to the losses of control that invariably happen when you consume these substances (when you feel controlled by the drug instead of vice-versa), and you realize the price being paid for every intake.
The Drug Lineup
In this section, I discuss the most commonly abused drugs. The major categories include: sedatives, stimulants, narcotics, psychedelics, anti-anxiety and antidepressant drugs, volatile hydrocarbons, dissociative anesthetics, and steroids.
As I discuss the menu of available substances, remember that all are dangerous. When you choose to ingest any of these, you are deliberately leaving the map of human safety and caution. Maybe you’re doing it because life has felt too cautious up till now. Maybe you’ve felt unsatisfied or injured. But you need to be clear about the risks, as some substances and behaviors are distinctly more dangerous than others. Exactly how dangerous depends on the dose and on your immediate health. Keep in mind that the less sure you are of what you’re taking or doing, the more vulnerable you are to a range of uniquely personal reactions — some people have big reactions to even small amounts of a substance (due to genetics, allergies, and other sensitivities).
You may see reference in the addictions field to controlled substances. This term refers to the legal status of certain substances. Typically, nicotine and caffeine aren’t designated as “controlled” because they’ve been used for a long time and have become socially acceptable. However, their social acceptability does not account for how addictive they are.
Marijuana (THC)
Marijuana, or cannabis, comes from the hemp plant Cannabis sativa. To best estimates, it has been used for mind-altering and medicinal purposes for 12,000 years. The mixture of dried leaves can be green, brown, or gray in color. Marijuana’s key chemical is THC or tetrahydrocannabinol; however, more than 400 other chemicals are present as well.
Marijuana is consumed in multiple ways, but it is most often smoked or vaped, brewed in a tea, or mixed into food (such as brownies). Where cannabis is legalized or decriminalized, candies (soft or hard) are mass-produced for consumption and are sold with information regarding dose.
The addiction potential of marijuana is being actively researched. Addictive interactions often revolve around the release of the neurotransmitter dopamine. Substances that cause greater amounts of dopamine release are considered to be the most addictive. It’s already clear that the THC-related dopamine release is significantly less than with other psychostimulant agents like amphetamine.
Aside from the addictive potential, the psychological dependence effects of marijuana are firmly established and can become significant over time. You may feel you need marijuana to relax. But keep in mind that using marijuana to relax rather than other methods can result in increasing dependence, which means you may need ever-increasing doses to overcome tolerance. You may also experience negative emotions associated with withdrawal, including feelings of lethargy and reduced motivation that affects your functioning at work, school, and home.
Sedatives and tranquilizers
Sedatives and tranquilizers are depressant drugs (they slow and limit brain function). Sedatives are often used for sleep-assistance, relaxation, and anti-anxiety calming effects. Tranquilizers are more often used for their anti-anxiety effects.
Alcohol
Ethanol is a particular form of alcohol produced by fermented foods and grains. The most common sources are barley, hops, grapes, and potatoes. Other available alcohol types are highly poisonous even in small quantities. These include methanol (usually found in glass cleaners), isopropyl alcohol (rubbing alcohol), and ethylene glycol (automobile antifreeze solutions).
In this book, when I refer to alcohol, I solely means ethanol.
Alcohol depresses the actions of the brain, causing progressive impairment and a reduction in the signaling flow altogether. In addition to disinhibition, the most common effects are memory loss (sometimes as extreme as complete blackouts), confusion, disorientation, uncoordinated movement, lethargy, coma, and respiratory shutdown (which can be and often is fatal).
Alcohol, although legal in most countries, has roughly about the same addiction potential as cocaine. Surprised? Unfortunately, the legal status of a drug is not yet based on its addictiveness. Tobacco, another highly addictive substance (even more addictive for lab animals than cocaine), is also legal.
Pharmaceutical sedatives
Sedatives are usually prescribed for sleep and anxiety. These drugs should be used only over a short-term (five to seven days) because they carry significant risks for dependence and tolerance. Over the longer-term, use of this class of drugs will likely bring on irritability, lethargy, decreased motivation, vivid and disturbing dreams, nausea, headache, skin rash, tremors, a change in appetite (loss or increase), and sexual impairment.
The commonly known pharmaceutical sedative drugs are Valium, Librium, BuSpar, Equanil, Miltown Serax, Klonopin, and Halcion. These substances, known as benzodiazepines, are taken by mouth in pill form and give many a welcome sense of relaxation and well-being. They also lead to drowsiness, confusion, slurring of speech, and memory problems. Methaqualone (Quaaludes, Sopor, Parest) became, at one time, a popular party drug although it has most recently fallen into disfavor.
DATE RAPE DRUGS
Two drugs in the pharmaceutical sedative class are known as “date rape” drugs because of their properties (colorless, odorless, only slightly salty), their knockout potential, and the effects on memory.
GHB (also called Georgia Home Boy or grievous bodily harm) is a sedative-hypnotic that causes sleepiness and dizziness. With an overdose, there is a loss of consciousness. Combining this drug with alcohol is particularly risky because breathing can become dangerously slow. The primary effect occurs between 10 minutes and 1 hour after ingestion, but it can last 2 to 3 hours with residual effects for as long as 24 hours.Rohypnol (often called Roofies) is the brand name for a benzodiazepine (flunitrazepam), which is much stronger than Valium (diazepam). Sedation occurs usually within 30 minutes after ingestion and lasts for several hours. Roofies, like GHB, are dangerous when taken with alcohol. If you ingest this drug, chances are your memory will be impaired, and when the drug effect wears off you may have difficulties remembering where or when you took it and what happened afterwards.Sedatives have a high addiction potential because they’re short-acting and tolerance builds quickly (requiring more drug to get the same mind-altering effect).
Barbiturates
These drugs include mephobarbital (Mebaral) and pentobarbital sodium (Nembutol). They’re used for sleep disorders. Acting on the GABA neurotransmitter system, they slow brain activity, thereby producing a calm feeling. Like all depressants, they have a potential for tolerance, physical dependence, withdrawal effects (watch out for seizures), and, ultimately, addiction.
Barbiturates are controlled substances because of their high addiction potential. They effectively numb your mind although, over time, higher and higher doses are required to achieve similar effects.
Stimulants
Stimulants are a class of drugs that increase alertness and physical activity. They include amphetamines (pharmaceuticals such as Dexedrine and Biphetamine also known as speed), methamphetamines (meth, chalk, ice, crystal, glass), and cocaine (blow, bump, coke, Charlie, rock, snow, toot). If you start using these drugs, chances are high that you’ll develop intense cravings for more.
Stimulants may be taken in different forms: swallowed, snorted, smoked, or injected. Injecting stimulants is the riskiest method (due to needle infections) and swallowing is the safest— from the immediately physical viewpoint, at any rate.
Stimulants increase heart and respiration rates, increase blood pressure, dilate (expand) the pupils, and decrease appetite. The last side effect was once a sought-after attribute of stimulants in their use as weight-loss drugs. Now we know there are much safer and less addictive drugs with appetite suppression properties (such as Liraglutide).
Amphetamines
Amphetamines are psychologically addictive because people become dependent on taking more to avoid feeling the depressing withdrawal. If you suddenly stop using the drug, you end up tired, sleepy, irritable, and depressed. The severity and durations you experience these effects vary depending on the degree of abuse. (See Chapter 10 for more information on withdrawal effects from these substances.)
Cocaine
Cocaine hydrochloride is a white powder derived from the leaves of the coca plant. Cocaine used to be sold over the counter in many forms (yes, in Coca Cola). Crack cocaine is made by altering cocaine powder into crystals or rocks that can be smoked. Cocaine is short-acting (the effects peak after 15 to 30 minutes), so users are very motivated to periodically get another hit to maintain the buzz. Cocaine is highly addictive.
Psychedelics
We often think of psychedelics as current drugs, but for thousands of years, psychedelics have been used by people for far-ranging journeys inside their own minds. Psychedelics can profoundly distort reality.
