One addiction at a time? Not necessarily

Addiction and Recovery

By Bob Gaydos

      Once upon a time, not that long ago, you used to be able to find an AA meeting by looking for a church with a cluster of people standing outside and smoking. That’s still possible, but the clusters have grown smaller. More significantly, as people in recovery joined much of the rest of society in quitting smoking, the air in the meeting rooms cleared up and ash trays disappeared from the tables.

      But it wasn’t easy. Many people in recovery say snuffing the cigarettes was much harder than putting down the drink or the drug. Until recently, that belief, supported by research, meant recovery programs focused solely on the alcohol addiction and left the nicotine addiction to be addressed at a later time, if the person so desired. It was too hard to do both at the same time, the thinking went, and the primary goal was to address the substance abuse.

      This, even though statistics showed that: 1. more than 80 percent of clients in rehab were smokers; 2. people with addictions to alcohol (or other drugs) were significantly more likely to be smokers than those without an alcohol abuse disorder (17 percent of adults); and 3. people who have been treated for alcohol problems were more likely to die of health issues related to tobacco than to alcohol, since they have a higher risk of heart disease and cancer than non-smokers. Also, non-smokers in recovery live longer than smokers in recovery.

      Time and research have changed the treat-one-addiction-at-a-time philosophy, at least to the extent that more rehabs are now offering stop-smoking programs as well as traditional alcohol/drugs programs. This may have something to do with the fact that surveys have shown that a sizable majority of smokers in treatment for alcohol or drug addiction say they also want to quit smoking and that they think it is better to do so within six months of stopping drinking or using drugs rather than waiting until later.

      A primary motivator for quitting smoking early in recovery from alcohol abuse is the strong connection between smoking and drinking. For many alcoholics, the two activities went hand-in-hand. In direct contradiction to previous thinking which said quitting smoking would make it harder for people new to recovery to stay sober, some treatment specialists today say that continuing to smoke while not drinking can be a strong trigger for relapse. Nicotine stimulates the brain’s pleasure receptors, feeding the “need” for more.

      No one says it’s easy to quit smoking and drinking at the same time, but it’s often suggested to use the motivation and strategies used to stop drinking to also stop smoking. That means, for certain, not trying to do it on one’s own, but rather, being open to a variety of help from behavioral therapists to nicotine replacement therapies, to encouragement from friends and family, to online and in-person support from groups such as Nicotine Anonymous (https://www.nicotine-anonymous.org) and the American Lung Association (https://www.lung.org/stop-smoking).

       Ideally, recovery from alcohol or other drugs means adopting a healthier lifestyle including exercise, proper nutrition and emotionally or spiritually rewarding behaviors. Smoking doesn’t qualify.

Bob Gaydos is a freelance writer. rjgaydos@gmail.com

  

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

How to spot a food-related addiction

Addiction and Recovery

By Bob Gaydos

The list of substances or behaviors to which adolescents can become unhealthily attached, even addicted, can seem endless to a parent inclined to be caring and protective: alcohol, smoking, drugs, gambling, video games, social media, internet, cell phones, sex, shopping, eating …

Wait, eating you say? Yes, eating. Or food. It depends. There’s a debate over whether the problems are the same thing. Some say that someone who craves the same food, say sweets or salty chips, and consumes it in unhealthy amounts might be considered a food addict, a term not universally accepted, but one that is useful in defining a behavior. The food in question reacts on the brain in the same way that alcohol or another drug would. It rewards the person, who feels good.

Some say that someone for whom eating -- anything and plenty of it -- is a fulltime job with significant negative consequences might be considered to have an eating addiction, rather than a food addiction. Eating may provide the same kind of escape and temporary excitement that gambling, for example, would in someone else. An irresistible reward.

And, of course, these harmful behaviors often co-exist. Addictions may have biological, psychological, or social causes, or, likely, a combination of them.The focus here is not on debating the food/eating addiction question, but rather on recognizing that food addictions and eating disorders -- a different category of self-destructive behavior, including anorexia, bulimia and binge eating -- can often be ignored in teens when there is so much talk in media -- social and otherwise -- about drinking and driving, opioid abuse, the pros and cons of marijuana and the rest of that list.

Teens eat, adults say. Sometimes they eat a lot. Maybe a lot of junk food. They’re growing. So what’s the big deal?

Maybe nothing; maybe something. A primary goal of this column is to provide useful information to help readers identify and get help for addictive behavior and some studies say up to 10 percent of Americans may have a food-related addiction or disorder. One in 10 female teens may have an eating disorder. A smaller percentage of teen boys, perhaps athletes such as wrestlers or runners, also have issues that revolve around body weight and image. What follows are some symptoms and questions to help you decide if you or someone you know, perhaps a teenager, has a health issue involving food.

The following are possible symptoms of a food addiction:

• Gorging
• Eating to the point of feeling ill
• Going out of your way to obtain certain foods
• Continuing to eat certain foods even if no longer hungry
• Eating in secret
• Avoiding social interactions, relationships to spend time eating certain foods.
• Difficulty functioning in a job or school due to decreased efficiency
• Spending a significant amount of money on buying certain foods to binge
• Obesity
• Fatigue
• Difficulty concentrating
• Sleep disorders, such as insomnia or oversleeping
• Headaches
• Irritability
• Digestive disorders
• Thoughts of suicide

Food Addicts in Recovery Anonymous, a 12-step group that seeks to help people with food addictions or disorders, offers its own quiz to help people determine if they have a problem with food. As always, answer as honestly as possible:

1. Have you ever wanted to stop eating and found you just couldn't?
2. Do you think about food or your weight constantly?
3. Do you find yourself attempting one diet or food plan after another, with no lasting success?
4. Do you binge and then "get rid of the binge" through vomiting, exercise, laxatives, or other forms of purging?
5. Do you eat differently in private than you do in front of other people?
6. Has a doctor or family member ever approached you with concern about your eating habits or weight?
7. Do you eat large quantities of food at one time (binge)?
8. Is your weight problem due to your "nibbling" all day long?
9. Do you eat to escape from your feelings?
10. Do you eat when you're not hungry?
11. Have you ever discarded food, only to retrieve and eat it later?
12. Do you eat in secret?
13. Do you fast or severely restrict your food intake?
14. Have you ever stolen other people's food?
15. Have you ever hidden food to make sure you have "enough"?
16. Do you feel driven to exercise excessively to control your weight?
17. Do you obsessively calculate the calories you've burned against the calories you've eaten?
18. Do you frequently feel guilty or ashamed about what you've eaten?
19. Are you waiting for your life to begin "when you lose the weight"?
20. Do you feel hopeless about your relationship with food?

A “yes” answer to any question could indicate a problem with food, the group says.

Obviously, these are complex issues with serious -- even life-threatening -- potential consequences that need to be addressed as early as possible by trained professionals. There are a variety of programs and organizations to turn to If you suspect a food-related problem. Consult your doctor to begin with and check any of the accompanying links for more information.

For help

-- www.foodaddictsanonymous.org

-- www.recoveryfromfoodaddiction.org

-- www.foodaddicts.org

-- www.oa.org

-- www.eatingdisordersanonymous.org

-- www.nationaleatingdisorders.org

-- www.nimh.nih.gov

-- www.mentalhealthamerica.net

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Fentanyl: From blessing to curse

Addiction and Recovery

By Bob Gaydos

Fentanyl.

The word strikes fear into everyone involved in fighting America’s epidemic of opioid overdoses. It was approved for medical use 50 years ago as a potent pain killer. Today, it is increasingly thought of simply as a killer.

In January, in a five-day period, there were five overdose deaths in Orange County, N.Y.. Fentanyl was involved in each one. In the past couple of years, drug dealers have taken to adding fentanyl or analogues of it to the heroin they sell, making it many times more powerful and dangerous, since their customers don’t know it’s in the mix. Fentanyl is used orally, smoked, snorted, or injected. It can be hundreds of times more powerful than street drugs. The synthetic opioid was cited as the cause of 20,100 deaths in the United States in 2016, more than any other pain killer or heroin.

David Hoovler, Orange County district attorney, says 88 people died in Orange County from confirmed or suspected opioid overdoses last year. Performers Prince and Tom Petty are both said to have died from accidental overdoses of pain medications that included fentanyl.

While the White House has declared an opioid emergency in the country, it has devoted little time, money and energy to fighting it thus far. That makes it incumbent on citizens frightened at the rising death toll, especially among young people, to do their part in turning the tide. That effort always starts with information and truth is, despite its frequent appearance in headlines, social media and in TV reports, a lot of people don’t know much, if anything, about fentanyl. Consider this a basic introduction to the killer pain killer.

In its prescription form, fentanyl is known by such names as Actiq, Duragesic, and Sublimaze. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Signs and Symptoms

According to the National Institute on Drug Abuse, common signs that someone is abusing fentanyl include:

• Confusion
• Depression
• Difficulty walking
• Altered heart rate
• Labored breathing
• Slurred speech
• Weakness
• Dizziness, lightheadedness, and fainting
• Shaking

• Sleepiness
• Visual hallucinations
• Nausea and vomiting
• Pinpoint pupils

    Long-term fentanyl use can produce several adverse effects beyond the symptoms listed. They include:

• Severe gastrointestinal problems
• Seizures
• Weakened immune system

• Paranoia
• Social withdrawal
• Lack of motivation
• Delusions and personality changes

And of course, when combined with other street drugs like heroin, fentanyl can cause respiratory distress, coma or death.

The latter is something with which America has become all-too-familiar. Even here, though, there is help. According to the Substance Abuse and Mental Health Services Administration, “The evidence is strong for the use of naloxone to reverse the effects of an opioid overdose. Distributing naloxone and teaching people to use it is an effective means of preventing deaths among people who misuse heroin, fentanyl, prescription opioids, and other opioids. With brief training, most adults can learn to administer life-saving naloxone.”

If you are interested in starting a naloxone program, need to find out how to obtain naloxone to prevent overdoses, or simply want more information, SAMSHA’s Opioid Overdose Prevention Toolkit – 2016 includes sections for physicians, first responders and family members on administering naloxone. Many local organizations have already taken this step.

Finally, if you have a prescription for fentanyl or any opioid and are concerned about a young person in your household gaining access to it -- the most common way teenagers can get it -- keep it in a locked location and keep a record of how much of the prescription you have used. And by all means do not be reluctant to have that talk about drug abuse and the special risks of abusing prescription drugs.

Treatment for addiction to fentanyl should include detox supervised by a medical professional as withdrawal symptoms can be severe. The usual follow-ups -- in-patient or outpatient rehab and 12-step recovery programs -- are strongly suggested.

Earlier this month, Governor Andrew M. Cuomo announced a 30-day budget amendment to add 11 fentanyl analogs to the state controlled substances schedule to help support law enforcement efforts to stop the spread of the drug. DA Hoovler says any help for law enforcement on illegal drugs is welcome, but much more investment is also needed in prevention and treatment for all opioid abuse, including ongoing anti-drug programs in schools and treatment on demand for addicts. Those who want help should be able to get it. If enough people demand it, perhaps the White House will hear.

*  *  *

More information

NIDA: www.drugabuse.gov

SAMSHA: www.samhsa.gov

Narcotics Anonymous Mid-Hudson: 845-431-9011; www.newyorkna.org

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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

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