Maybe there‘s a little addiction, disorder in all of us

Addiction and Recovery

By Bob Gaydos

   
Opioids and alcohol get most of the attention, although marijuana, currently undergoing a reputation rehabilitation, has been grabbing plenty of headlines lately. But if you spend any amount of time studying the issue, it doesn’t take long to wonder if there isn’t an addiction, compulsion, behavioral disorder — call it what you will — for every human on the planet.

    Some conditions are more serious than others, but all

either involve the brain’s reward system or relieve anxiety, stimulate compulsive use and bring with them an opportunity for negative consequences. Consider the following an inventory of sorts, a look at some of the substances people use or behaviors they engage in, perhaps to excess. Maybe someone you know shows some of the signs of trouble.

Medically recognized substance use disorders

    Alcohol Use Disorder: Alcohol is a depressant. Alcohol use disorder is more common among adult men than among women, but the gap is narrowing. It typically develops at a young age. Severe use is commonly referred to as alcoholism.

Caffeine Intoxication: Heavy intake of caffeine resulting in symptoms including restlessness, nervousness, insomnia, gastrointestinal disturbance, rambling thoughts and speech, cardiac rhythm disturbances.

Cannabis Use Disorder: Highest among 18- to29-year-olds. Often the first drug used and often used with other drugs. Prevalence decreases with age.

Hallucinogen Use Disorder: These substances alter perception. Phencyclidine — “angel dust” or PCP — produces feelings of separation of mind from body.

Inhalant Use Disorder: Sniffing glue. Inhalant substances are volatile hydrocarbons, toxic gases that are released from glues, fuels and paints, that can have psychoactive effects. Occurs primarily among ages 12 to 17.

Opioid Use Disorder: Opioid drugs include heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl. According to the American Society of Addiction Medicine, opioid-related overdoses are now the leading cause of death in Americans under 50 years of age and prescribed opioids are the “overwhelming initial source” of addiction.
    Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications (Valium, Xanax, Librium). These are brain depressants. Rates are highest among 18- to 29-year-olds.
    Stimulant Use Disorder: This group include amphetamines, Ritalin and cocaine. These drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Cocaine use in the U.S. is highest among those aged 18 to 25.

Tobacco Use Disorder: Nicotine in tobacco acts as a stimulant for the central nervous system. Studies show that 68 percent of adult smokers want to quit and 50 percent of smokers have tried.

Behavioral disorders

Binge-eating disorder (overeating disorder): Uncontrolled eating, often accompanied by purging (bulimia).

Gambling disorder: Because of the quick feedback, it can provide reward symptoms to the brain much like alcohol or cocaine.

        Gaming disorder: It has been recognized officially by the World Health Organization, but is still under study in the United States for classification as an addictive behavior. Other behaviors under study include smartphone use, Internet gambling, pornography, eating and shopping.

Compulsive behaviors

        These can include such things as hoarding, shopping, sex, eating, gambling, exercise, even talking compulsively. While the behaviors may not provide the pleasure reward of an addiction, they serve to relieve anxiety and stress and, if unchecked, can have serious negative consequences in a person’s life.

What else to know

        Simply put, an addiction is a repetitive use of a substance or engagement in a behavior because of the rewards message the substance or behavior transmits to the brain, despite numerous negative consequences the activity produces in the person’s life. Tolerance increases with time. The person may not even be aware of the damage being done by the behavior, or may continue in spite of it. At some point, the substance or behavior may dominate the addicted person’s daily life. It is highly likely that these conditions are accompanied by other mental health conditions, such as anxiety or depression.

    Science has been unable to come up with one cause of addiction, nor can it predict who will become addicted. However, there are numerous risk factors that can be recognized, some of which may be avoidable, some not. Genetics/family history play a significant role in determining vulnerability as do environmental factors, including growing up in a dysfunctional family and early exposure to substances or abuse. The presence of other mental health issues can also contribute to susceptibility to addictive behavior. Even physiology may play a role since men seem to be more susceptible to addiction than women.

That said, there are a number of conditions that can predict the presence of an addiction. The following list is adapted from one used by the Mayo Clinic. Substitute the specific substance or behavior for the word “drug.”
    — Feeling that you have to use the drug regularly — daily or even several times a day.

— Having intense urges for the drug that block out any other thoughts.

— Over time, needing more of the drug to get the same effect.

— Taking larger amounts of the drug over a longer period of time than you intended.

— Making certain that you maintain a supply of the drug.
    — Spending money on the drug, even though you can't afford it.
    — Not meeting obligations and school, family or work responsibilities, or cutting back on social or recreational activities because of drug use.
    — Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm.
    — Doing things to get the drug that you normally wouldn't do, such as stealing.
    — Driving or engaging in other risky activities when you're under the influence of the drug.
    — Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug.
    — Failing in your attempts to stop using the drug.
    — Experiencing withdrawal symptoms when you attempt to stop taking the drug.

Generally, two or three symptoms suggest a mild disorder, four or five a moderate one and anything more, a severe disorder.

The good news is that there is a variety of treatment available for all these conditions. If a problem is suspected, don’t try to deal with it alone. Consult with a health professional (doctor, psychologist, social worker, addiction specialist) and begin the road to recovery.

America is in need of an intervention

By Bob Gaydos

The First Family ... in need of an intervention?

Democrats are talking about impeachment. Robert Mueller is looking at indictments. I’m fine with both, but honestly, more than anything else, I think America needs an intervention. Our addict-in-chief is out of control.\\\\

In addition to writing a blog for the past 10 years, I have been writing a monthly column called Addiction and Recovery. The goal always is to provide information on issues that are widely misunderstood. Like non-drinkers behaving like full-blown alcoholics.

Like Drumpf.

The Dotard-in-chief has talked sparingly about his respect for the power of alcohol, noting that his brother, Fred, died of alcoholism and at least implying that this may be the impetus for the Donald’s tea-totaling ways. But professionals in the field of addiction and alcoholics in recovery will tell you that alcohol is but one symptom of the disease. Take away the alcohol but change nothing else and you have what’s known as a “dry drunk.” That’s someone who has all the “isms” and can be so miserable to be around that people often wish he or she were drinking again.

They’ll also tell you it’s a family disease. It can cross generations, skipping here, striking there and can manifest in many ways. To repeat, alcohol need not be present for alcoholism 

to exist. It generally just makes it easier to spot.

What got me thinking about Drumpf and alcoholism was the obvious state of withdrawal he went into following the defeat of so many Republicans in the mid-term elections, culminating in the Democrats reclaiming the House of Representatives. It was bad enough to drive a man to drink. He was obviously depressed and reportedly irritable and angry at everyone in the White House. He even blamed Republican losers for not soliciting his support. He claimed Democrats voted more than once by changing clothes outside polling places. He fired his attorney general. He sat in his hotel room in Paris, watching TV and refusing to attend ceremonies at a cemetery to honor Americans who died fighting in World War I. Because it was raining. He was pouty with all the assembled world leaders, save for his buddy, Vladimir Putin, who managed to bring out a smile in him.

Why Putin?

Well, for one thing, the Russian president may be the only head of state who hasn’t let it be known, directly or otherwise, how little regard he has for Trump, as a person or a president. I think it’s fair to assume that Putin buffs Trump’s huge, fragile ego every time they meet. Especially in private. That’s because Putin is smart and Trump is a sucker for applause, adulation, approval.

It’s his alcohol.

The other factor in his more-erratic-than-usual behavior of the past week or so was the absence of political campaign rallies in his life. Leading up to the elections, they were an almost daily ritual. Get on a plane; fly here or there; make up scary stories of caravans of immigrants threatening America; rile up the base; hear them cheer. Look at all those MAGA hats! This is great! Bartender, hit me again. …

Whaddya mean it’s closing time? I’m the president and you’re not. I want another campaign 

stop. They love me. Let’s do Arizona again. Tell them I’ll give them a tax cut.

It’s tough to go back to work after that, especially when you hate your job and know you don’t know how to do it but have to act as if you do. Alcoholics tend to have large egos and low-self esteem. This is often disguised by an outsized personality or an ability to persuade people.

Sound familiar?

Dr. James West, founding medical director of the Betty Ford Clinic, who was described by the clinic’s director as “an addiction physician before there was even that term,” also wrote a column on addiction that appeared in the Desert Sun, a daily paper in Palm Springs, Calif. in the 1990s. One column addressed the question of an “alcoholic personality” in someone who doesn’t drink.

“Generally,” he wrote, “alcoholics seem to have the same kinds of personalities as everybody 

else, except more so.”

Among traits, he said, “The first is a low frustration tolerance. Alcoholics seem to experience more distress when enduring long-term dysphoria or when tiresome things do not work out quickly. Alcoholics are more impulsive than most. Secondly, alcoholics are more sensitive.”

“Alcoholics have a ‘low rejection threshold.’”

Don’t we know it.

Dr. West, who was a recovering alcoholic himself, died in 2012 at age 98. He also wrote: “Another trait found in excess in alcoholics is a low sense of one's own worth. Then there is isolation. Alcoholics are loners. It is with most difficulty they are able to share innermost thoughts and concerns with anyone.

“Although they may be articulate, charming and very persuasive, they operate behind an armor or shell that keeps the world out. They are afraid of intimacy.”

This brings me back to Trump and the subject of an intervention. Much as I think it’s needed, I don’t see it happening. It’s usually the family and close friends who initiate such a drastic step. Melania seems to have accepted her role as wifely enabler, probably with a sweet pre-nup. The two older sons are chips off the same old block and probably fear daddy’s wrath. Ivanka, the apple of his eye, obviously does not see herself suffering from his addiction. Should that ever happen, the dynamic could change dramatically.

Which is to say, intervention for America from this First Family addiction could come from an interested third party, say in the form of a Robert Mueller indictment of Ivanka, or one or both sons. A moment of stark clarity for the Trumps. No cheering crowds. No MAGA hats. Lots of lawyers and legal fees.

“Daddy, turn off the TV. We need to talk …”

rjgaydos@gmail.com

Shedding some light on blackouts

Addiction and Recovery

By Bob Gaydos

There are two enduring views about alcohol-induced blackouts:

1. They don’t exist. They’re just an excuse for inappropriate behavior.
2. They exist, but they’re just a harmless, often humorous, occasional price to pay for a night of fun.

Both views are wrong — dangerously so — for the same reason: Denying the existence of blackouts or minimizing their significance could lead to serious consequences (health, legal, personal, professional) for the persons experiencing them and others. If you’ve experienced blackouts or know someone who has and are not concerned about them, you should be.

To start with, blackouts are not the same as passing out. That’s a comomon misconception. People who drink too much and pass out stay put. They wake up in the same place they passed out and remember, maybe with a hangover, how they got there. People in blackouts can wind up in different states, strange beds, wrong apartments or behind bars when they come to and not know how they got there. “How did I get home last night?” is a common question for blackout veterans. “Where’d I leave my car?” is another.

Many recovering alcoholics who recall their drinking history in Alcoholics Anonymous meetings point to blackouts as one of the “healthy fears’’ that help them stay sober. After all, it can be frightening to find out about some reckless behavior that happened apparently in a blackout and to wonder what else may have happened without your being aware of it.

Some local examples:

— Jordan, a 50ish man from Orange County, who has been sober more than five years, says he once spent a four-day business trip in Texas in a blackout. Airport-to-airport. He did come out of it briefly, he says, to call his boss on Day 2 to tell him he wasn’t feeling well.

— Whitey (all names used are fictitious), who drives for a living, says he regularly drove between New York and Virginia in blackouts.

— John, retired in Sullivan County and sober more than two decades, says he’s positive he was fired from an excellent job because of remarks he made to his boss’s wife while in a blackout.

— Marie, a chef sober less than a year, says she has no recollection of a phone call in which she was extremely rude and insulting to her husband’s sister, other than what her husband and sister-in-law told her. She’s embarrassed by the incident.

— Sunshine, a nurse sober half her life, recalls with a mix of horror and shame coming out of a blackout “as a guy was trying to have sex with me.” She says she fought him off. But she didn’t immediately stop drinking.

That’s often the case — not stopping drinking despite risky or embarrassing consequences. As an isolated incident, a blackout may not signify anything except drinking too much, too fast. Something you might want to avoid because of potential embarrassment or worse. As a pattern, it could be a sign of a more serious problem.

While it’s not just alcoholics who experience blackouts, the connection between blackouts and alcoholism or alcoholic use disorder is real and knowing some facts about the symptom could help dispel some of the myths and avoid more serious problems.

For a long time — most likely from whenever humans first discovered the mood-altering effects of wine until modern science started doing research on the brain and behavior — blackouts were regarded as just one of the possible side effects of drinking alcohol. A little fuzzy memory. No big deal. Just drink less.

When researchers began studying blackouts, however, they soon discovered that persons experiencing them didn’t have just a little amnesia. Rather, they had no recollection of certain events and, try as they might, even when told the details many times over, they had no memory of them. Their research subjects didn’t forget, researchers concluded; they never formed a memory in the first place.

The prevailing accepted science, as cited by the National Institute on Alcoholism and Alcohol Abuse and other similar agencies, is that persons experiencing a blackout can function and appear to be “normal” to others because their brain is operating on stored, long-term, procedural memory, but the short-term memory of what they are experiencing never gets to the hippocampus, the part of the brain that processes long-term memory. Alcohol — especially a lot of it in a short period of time — short-circuits the process.

According to the NIAAA, “As the amount of alcohol consumed increases, so does the magnitude of the memory impairments. Large amounts of alcohol, particularly if consumed rapidly, can produce partial or complete blackouts.”

More about blackouts:

— It’s not what you drink, it’s how much alcohol gets into your bloodstream and how fast it gets there. This means it’s possible for anyone to black out if he or she drinks enough alcohol quickly enough.

— People who have a low tolerance for alcohol are not necessarily more likely to black out. On the other hand, those with a high tolerance for alcohol are often able to drink heavily and carry on conversations, drive, etc. while in blackouts.

— Women may be more susceptible since they tend to be smaller than men, meaning each drink has a greater effect on the body’s blood alcohol content.

— Drinking on an empty stomach can make blackouts more likely, again because of a more acute impact on the blood alcohol concentration.

— People sometimes have glimpses of memory of an event, but not total recall. These partial lapses are called “brownouts.”

— Blackouts are the product of consumption of an amount of alcohol that affects motor coordination, balance, impulse control and decision-making. This is bad enough when someone is not in a blackout, never mind being unable to recall any risky, self-sabotaging behavior that may have caused serious harm to others.

— Some researchers suggest that people in blackouts, operating on procedural memory and little more, have little impulse control and are more likely to do things they would not otherwise do. (See examples above.) This presents embarrassing, sometimes dangerous situations for the person in a blackout, family, friends and even strangers.

— Blackouts are often the unrecognized explanation for someone’s uncharacteristic actions. “Why did you (say/do) that last night?”

— Because of a shortage of evidence-based science on the subject, there is considerable difference of opinion on the use of blackouts as a defense in criminal trials.

So, what to do if you have blackouts? Take them seriously. Maybe talk to a professional health provider who knows about them. While blackouts are not solely the result of years of heavy, alcoholic drinking, they can be a sign of an existing or potential alcohol problem. Even one or two — perhaps the product of binge drinking in college — should be enough to cause concern since not being aware of what one has done is not considered acceptable to most people.

Being the unaware “life of the party” may be tolerable as a one-time experience, but repeated bizarre behavior of which you have no memory is nothing to laugh at.

 BobGaydos.blogspot.com.

Know the warning signs of problem drinking

Addiction and Recovery

By Bob Gaydos

More than three drinks a day or seven per week
 is considered risky drinking for women.

There are “heavy-hitters,” “weekend warriors,” and petite women with ”wooden legs” who can drink burly construction workers under the table. There are also “social drinkers,” who simply enjoy a bottle of good wine with dinner and others who appreciate a few beers after a softball game.

Problem drinkers? Maybe, maybe not. More to the point, maybe a few at risk of becoming problem drinkers. April being Alcohol Awareness Month, it’s a good time to review personal drinking habits, if just to see if there are any warning flags of a potential future problem that can be avoided. It’s worth the time.

According to the National Institute of Alcohol Abuse and Alcoholism, about 88,000 people die from alcohol-related causes each year, making it the third leading preventable cause of death in the United States. Alcohol use disorder (AUD) affects 15-18 million adults. It’s a major health issue, but drinking is so ingrained in our society that many people are reluctant to look at their own drinking patterns. This common resistance to self-reflection, along with a lack of information on the risks of abusing alcohol, can be harmful to your health.

For example, having a high tolerance for alcohol, often worn as a badge of pride, is a reason to be wary. People with a high tolerance are likely to drink more and hang out with people who drink more and more often. They are at higher risk for AUD (alcoholism) and serious health problems affecting the liver, heart or brain caused by alcohol abuse. This is not to mention the obvious risks of drinking and driving and other physical harm as the result of impaired judgment.

Just one more example, for those who feel they drink “in moderation.” The NIAAA, which does research on these things, says, for men, more than four drinks on any day or more than 14 per week and for women, more than three drinks on any day or seven per week is “heavy” or “at risk” drinking. A standard drink is defined as one containing .6 fluid ounces of “pure” alcohol, regardless of the liquid -- a 12-ounce can of beer or a 1/1/2 ounce shot of some 80-proof liquor are the same.

The agency offers a list of questions to help determine if you have an alcohol abuse problem or are at risk of one:

In the past year, have you:

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn't?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Spent a lot of time drinking? Or being sick or getting over other after-effects?
• Continued to drink even though it was causing trouble with your family or friends?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Says the NIAAA: “Depending on the symptoms and their severity, just one or two can be a red flag. The more symptoms you have, the more urgent the need for change. The symptoms toward the top of the list tend to be early signs of potential trouble, whereas the ones further down the list indicate that you have moved further down a risky path.”

If you take the test on the NIAAA website (https://www.rethinkingdrinking.niaaa.nih.gov), it will provide individual feedback. The site is anonymous.

The gauge for determining alcohol abuse is actually simple: Alcohol is a problem when it causes problems in your life -- at home, at work, with your health.

Regardless of the results of the test, there are several factors that suggest quitting drinking might be advised:

• You’ve tried to cut down, but can’t.
• You have had some symptoms previously.
• Alcohol affects a physical or mental condition or it interacts with medication.
• You are pregnant.
• You have a family history of alcohol problems or a personal history of alcohol-related injuries.

The NIAAA website offers suggestions for cutting down on drinking if you think it could become a problem. If it already is, seek professional help. It won’t get any better by avoiding it.

bobgaydos.blogspot.com

At holiday parties, 'no thanks' is an acceptable answer

Addiction and recovery

By Bob Gaydos

It’s time for my annual here-come-the-holidays-so-let’s-be-smart-while-we-enjoy-ourselves column  for addicts and their friends and families.

Over the years of writing this column I’ve learned that being brief is important because there’s simply too much for people to do at this time of year to sit and read an article about healthy behavior. Also, that non-addicts as well as addicts can benefit from knowing some basic rules for surviving holiday festivities. If much of what follows sounds familiar, it’s because I’ve said it before and, I think, bears repeating.

This is a treacherous time of year for people in early recovery from addiction. People who have found their way to recovery, be it via a 12-step program or otherwise, have been given suggestions on how to survive the season of temptation without relapse. If they use these tools, with practice, they can even enjoy the season.

But I’m also talking here to you hosts, family members, well-meaning friends who want to be supportive and do the right thing, but aren’t sure what that is. And yes, to those who don’t understand the concept of addiction but can still avoid harming a relationship by following a few basic suggestions. So, first, some holiday coping tools for the non-addicted:

• “No thank you” is a complete sentence and perfectly acceptable answer. It should not require any further explanation. “One drink won’t hurt you” is a dangerously ill-informed reply. The same goes for, “A few butter cookies won’t hurt. C’mon, it’s Christmas.” Or, “Get the dress. Put it on your credit card. You’ll feel better.” Not really.
• By the way, “No thank you” is an acceptable answer even for people not in recovery. Not everyone who turns down a second helping of stuffing or a piece of pumpkin pie is a member of Overeaters Anonymous. Not everyone who prefers a ginger ale rather than a beer is a member of AA. Not everyone who won’t go into hock for an expensive New Year’s Eve party is a compulsive debtor. But some of them may be.
• If you’re hosting a party to which people in recovery have been invited, have some non-alcoholic beverages available. Not just water. Don’t make a big deal about having them, just let your guests know they are available. The same goes for food. Have some appetizing, low-calorie dishes and healthful desserts on hand. Don’t point out that they’re there because so-and-so is watching his weight. Just serve them. You’ll be surprised how many guests enjoy them and comment on what a good host you are.
• If you’re honestly concerned about how the person in recovery is doing, approach him or her privately. He or she might not feel comfortable discussing it in front of other guests. If you’re just curious, keep it to yourself.
• Honoring a guest’s wishes is a sign of respect. Anticipating them in advance is even better. Encouraging someone to eat, drink or spend money when they don’t want to is, at the very least, not gracious. Pressuring someone to partake of something when you know he or she is trying hard to avoid it is a good way to lose a friend.
• Addictions are not trivial matters. I repeat, “No, thank you,” is a perfectly good answer. Members of AA, OA and DA will be especially appreciative if you remember that.

For recovering addicts, the tools should be familiar, but always bear repeating:

• Bring a recovery friend to a party.
• Have phone numbers and your own transportation available if you want to leave an uncomfortable situation.
• If you’re uncomfortable about attending a party because of who will be there, be it family or friends who are not supportive, don’t go. Politely decline.
• Keep track of your drink. If you’re not sure, get a new one.
• Deal in cash; forget about credit cards.
• Don’t feel obliged to try every dish on the table.
• And, again, “No, thank you,” is a complete sentence. Don’t worry about hurting your host’s feelings at the expense of your recovery. There’s always next year.

Enjoy.

*  *  *

For more information:

Debtors Anonymous: www.debtorsanonymous.org

Alcoholics Anonymous: www.aa.org

Overeaters Anonymous: www.oa.org

Al-Anon: www.al-anon.org

bobgaydos.blogspot.com