ADDICTION & RELAPSE
by Sue Brooks, MA, LPC, LCDC
Stanton Peele, a psychologist, attorney, and addiction expert, famous for his 1975 groundbreaking Love and Addiction, recently wrote an article addressing the recent controversy, Are Addiction and Mental Illness Really Brain Diseases? Having worked in the addiction profession for 15 years, my concern with Peele’s question is not the question; it’s the potential answer. People these days are desperate, but not for answers – they only want one simple and definitive answer. And, it better be right, forever! Relapse is not an option. Relapse is failure. Or is it?
According to Thomas McLellan’s landmark study published in JAMA in 2000, relapse rates for substance (alcohol and drug) dependence are a little better than the relapse rates for hypertension and asthma and a little worse than the relapse rates for type II diabetes. To addicts and their families, these facts can bring a significant amount of relief. Further, when the subject of relapse is included in the discussion that I, for one, have yet to hear of anyone being turned away from a hospital emergency room for having yet another heart attack or yet another asthma attack, so why are addicts so stigmatized for relapsing?!, people’s frazzled nerves start to relax and their minds become more receptive to new information about addiction and mental illness. (I also realize that this logic has limitations in that medical complications usually don’t result in negative consequences involving the criminal justice system.)
Addicts and their families are constantly struggling with never ending crises and tragedies as they stumble through the minefield of addiction and mental illness. According to the National Institute on Drug Abuse (NIDA), drugs and alcohol are involved in 10-22% of drivers in crashes. Approximately 50-80% of all child abuse and neglect cases substantiated by child protective services involve some degree of substance dependence by the child’s parents. At least two-thirds of clients in rehab centers say they were physically or sexually abused as children. Last, but not at all least, substance dependence costs our nation almost $550 billion annually. We all need answers and solutions.
Thankfully, brain research is bringing forth much needed information. Pharmaceuticals in particular is a hot topic, but it is also a prime example of the complexity of addiction and mental illness. Some people unquestionably need pharmaceutical interventions. I have had clients engage with qualified psychiatrists and get the right medications in the right dosages, and weep in my office because they never knew they could “feel this kind of better.” On the other hand, society’s cravings for perpetual happiness and people’s unrealistic aversion to any and all pain – “take a pill, it’ll all go away” – can sabotage clients into thinking that they don't have to do any psychological and emotional work. Everyone's challenge – addicts and family members – is to understand how addiction works and how it affects both addicts and their families so that evidence-based interventions and treatment can ultimately be effective.
Yes, it would be wonderful for all of us if there was one definitive, simple solution. Unfortunately, the only certainties regarding addictions and mental illnesses, which often go hand-in-hand, are that they are (1) complex and multifaceted, and (2) recovery involving them takes time. But once this honest, realistic conversation is had, then clinicians and clients can start the assessment process to determine what challenges each particular client faces. Some clients may have more brain- and psychiatric-based challenges; some more developmental and family-of-origin issues; or some more related to current family disputes and lack of social support. Most probably, though, each client has some specific combination of all of the above. Let's start the process.
Originally published by Sue Brooks, in Inside The Net, vol. 17, issue 8, 9 August 2011.
Everyone is free to change.
Some just don't believe it yet.
The Facts +
= New Possibilities
Addiction was classified by the World Health Organization as a brain disorder in 2004. All drugs of abuse, including alcohol, marijuana, cocaine, ecstasy, crystal meth, painkillers, heroin, inhalants, and nicotine primarily affect the brain's limbic system, what scientists call the "reward" system of the brain.
Research is uncovering valid medical uses for marijuana, and I fully support the legalization and de-criminalization of marijuana for adults. That said, marijuana today is nearly twice as potent as it was in the 1980s. The most important thing is to understand the vulnerability of young, developing brains to increased concentrations of cannabis. Short-term effects include memory and learning problems, distorted perception, and difficulty thinking and solving problems. Nearly 45% of U.S. teenagers try marijuana before finishing high school.
The illegal use of painkillers (codeine, morphine, hydrocodone, oxycodone, fentanyl) and sedatives(benzodiazepines) is becoming more popular than marijuana, with the highest number of users between the ages of 12 to 25.
The reward center in the adolescent brain is not as fully developed or responsive as in the adult brain. Teen brains are hardwired to seek easy rewards. Teens are missing the neurologic brakes that adults have.
Cocaine and sexual pleasures affect the same part of the brain. Common health effects include heart attacks, respiratory failure, strokes, and seizures. Adults age 26 and older have the highest rate of current cocaine use, compared to other age groups.
Pathological obesity and drug addiction share common brain characteristics. A drop in blood sugar feels the same as a craving for cocaine.
Post Acute Withdrawal Syndrome occurs at 16 to 20 months of abstinence from all drugs and alcohol.
Many individuals addicted to substances or chemicals come to find that they also have what are called process addictions involving food (eating disorders, anorexia, binging/purging, etc.), sex (pornography, sexual anorexia, affairs, etc.), the Internet, trauma bonding, exercise, work, gambling, spending, and debting.
Many individuals may also have what are called relationship addictions involving romance addictions, love addictions, and trauma bonding.
By the year 2020, the number of addicts and alcoholics over the age of 50 is predicted to double.