Addiction

THE DISTRESS OF SUBSTANCE ABUSE

I come from a family chronically affected by alcohol addiction: I myself am a recovering alcoholic for the past 35+ years. Our family has been through the wringer over the traumatic consequences of this condition, both for sufferer and those who care about them. This article and the recommendations described are derived from my own experience together with my years of fitness training. I am not however credentialed in this field. You may disagree or have different experience with addiction than I describe. I encourage you to investigate further on your own. For the purposes of this discussion, addiction and substance abuse refer to the same thing.

How can you tell if you are addicted? There are many definitions and patterns of substance abuse differ greatly from person to person. One concept which serves me well is that you are probably addicted if you consistently consume more than you need and are driven to do so. So someone addicted to eating keeps eating as a rule even when their body is no longer hungry. The alcoholic continues to drink even after they are drunk.

Substance abuse characteristics: These attributes help us understand the dynamics of addiction and why it is often extremely difficult to successfully treat.

Addiction can result from abusing a substance (like alcohol) or from behaviors that do not serve us well (like gambling).
Logic and reason have nothing to do with addiction.
A fundamental trait of substance abuse involves the destruction of personal boundaries. This is a profound process and helps explain why this type of abuse is so hard to resolve.
Any problems that the addicted person has, other than the addiction, cannot be resolved until the addiction itself is addressed.
Substance abuse can transform the personality. We actually think differently under the effects of addiction. My father became a different person when he drank. A kind man turned into an abusive and angry one.
Successful treatment programs encompass more than just promoting the physical withdrawal from the substance.
Treatment is needed for the people around the addict. Family and friends are often drawn into difficult circumstances when living with someone who abuses substances. Deep and troubling problems can result for all involved.

The dynamics of addiction.

Lack of self discipline is not involved: There is a misconception that many people make about addiction. They seem to think that addicts simply need to have better self discipline. And many substance abusers think the same thing and constantly try to quit. The mechanism that determines using does not go through the thought process. It is instead a chemical and medicinal need that must be met. And that need cannot unfortunately be managed through self control.
If you abuse one substance, chances are you are susceptible to abusing others: For example, an alcoholic who quits drinking can easily fall into using a different substance like marijuana to deal with the trauma of quitting, substituting one addiction for another. Instead, choose a good substance to get addicted to.
An addict can't imbibe just a little: It is an all or nothing dilemma. A smoker can never have just one cigarette. The next day it becomes an entire pack.
The person addicted uses even if it causes ill health: Ever heard of the patient with severe lung disease who keeps on smoking?
Substance abuse disorder often runs in families: That is because there is an inherited component passed on through the genes. You even find entire populations more vulnerable to abuse. American Indians for instance are susceptible to alcohol abuse.

In essence:

There are 2 aspects to substance abuse:

The addict is dependent on using the substance.
Extended use has destructive effects.

These substances cause damage with addiction:

Alcohol: Misuse of alcohol is probably the most destructive of all substances, both from its popularity and from the devastating physical effects that alcohol abuse causes. There are many long term risks including: high blood pressure, stroke, pancreatitis, liver disease (cirrhosis), a number of different types of cancer, depression and dementia. Alcohol abuse affects the skin as well as the immune system. It is an addiction that can cause very serious health hazzards.
Nicotine: Cigarette smoking has become considerably less common in the United States, probably because of the tremendous public campaign against its use. (Smoking rates among adults have fallen by 73% since 1965.) Physical ill effects from smoking are terrible and range from lung cancer to emphysema. Any smoker will tell you that it is extremely difficult to quit.
Prescription drugs: Pain killers in the form of opioids cause particularly insidious addictions. Opioid addiction takes over swiftly and viciously. These pain killers are notoriously difficult to stop using. Commonly prescribed drugs which have addictive potential include: OxyContin, Percocet, Percodan, Vicodin, Librium, Valium, Xanax, Adderall, Concerta, Ritalin. The new weight loss drugs are potentially addictive as well. (I might add that the weight loss drugs are being found to cause very positive effects in other areas. The problem I see is dependency, not the destructive quality of the addiction.)
Illegal drugs: Many illegal drugs are extremely addictive including cocaine, heroin and methamphetamine. The latter, also known as speed, is especially damaging to the nervous system. Other drugs like marijuana are less addictive and/or have less damaging effects.
Gambling: This is among the most addictive behaviors that exist. Gamblers suffer greatly. It is extremely difficult to quit.
Food: 42% of American adults are obese. Our country has a food addiction. Far too many routinely eat more than their body needs to their great physical detriment. The effects of obesity can be extreme. For instance, the leg bones can become permanently deformed over time with the knees bowing in toward each other in an effort to support the extreme torso weight. Feet become deformed as well. Food addiction is turning out to be a very difficult condition to treat. New weight loss drugs have changed the prognosis but then once again you are substituting one addiction for another. Weight is regained when the drugs are discontinued.
Video games: This is an age associated addiction that is dangerous because of how it affects people's nervous system. For someone young this can be quite significant for their future endeavors.
Internet and social media use: History will find that the entire world population has gotten addicted to their iPhones. This is at the expense of interpersonal communication. (Notice how many couples eating dinner are reading their iPhones instead of talking to each other.) Intense social media use causes other problems too complex to discuss here. One significant issue is chronic neck tension from using your cell phone with resulting long term damage to the upper spine.
Shopping: Online shopping is especially addictive because it is so easy. It becomes abuse when we spend more than we have and yet we still keep on shopping.
Sex: Sex becomes addictive if it endangers us and yet we keep on pursuing it. Sex with strangers is one example.
Chronic inactivity has all the hallmarks of substance abuse. The less you do the less you want to do. We prefer being inactive to doing things even when it significantly impacts our health. We even refuse the exercise that relieves our pain because we prefer to do nothing. This is classic addictive behavior.

We can also get addicted to over the counter substances: Commonly abused medications include antihistamines, sleep aids, caffeine, ephedrine, pseudoephedrine, antitussives and expectorants, dextromethorphan, laxatives, anabolic steroids, and sildenafil. Sugar (in all its forms) should be added to that list. Consistent use is one warning flag. But to me an important guide post is if you keep taking more of the substance than you need.

Not all addictions are bad:

Some addictions are good for us. One idea to try is to substitute a good addiction for a bad one. Exercise instead of drinking for example. The trick is to become passionate about these things. Here are some good addictions:

Exercise: Weight lifting, yoga, Pilates, walking, hiking, sports. Anything physical you do consistently is a great alternative to substance abuse because the additional movement will in all likelihood increase oxygen absorption and generate a feeling of well being.
Meditation: Structured meditation is an excellent way to reduce stress. Starting a meditation practice would be a superb accompaniment to quitting a substance. It would make withdrawal and everything else easier.
Gardening: This is another great way to increase oxygen intake. Plants naturally need carbon dioxide and expel oxygen, the opposite of what humans do. The increased oxygen environment is wonderful for us.
Creative pursuits: Music, singing, art, dance, writing. Follow your passions. Early dreams often give us hints of the direction to take. Maybe you used to dream about taking singing lessons. Or take a class in painting with pastels.
Crafts: Sewing, scrapbooking, knitting. These are simply great ways to spend your time. Anything involving the hands is wonderful for the nervous system and to help restrain arthritis.
Hobbies: Classic cars, woodworking, home improvement projects, animal care, giving speeches.
Improve your diet: Become familiar with using food to enhance health. Learn about an anti-inflammatory diet.
Study a new language: Spanish is an especially valuable language to learn. This is a wonderful brain stimulant and is often recommended for lowering dementia risk.
Crossword puzzles: Any puzzles are wonderful for the brain. A much better way to spend your time than watching TV.
Chess, bridge: Highly recommended for supporting brain health.
Go back to school: Take courses in subjects you have always wanted to learn about.
Join a reading club: Start a habit of reading a book a week.
Become a volunteer, help others: There is nothing better than helping someone else. The feeling it gives you is so positive and so powerful and to top it off someone else is better off.

Statistics on substances: (Behaviors are not considered in these numbers. Only drugs, cigarettes and alcohol.)

The 5 most addictive substances in order from most to least:

Cocaine
Methamphetamine (speed)
Opioids
Alcohol
Nicotine

The most difficult substances to quit:

Heroin and other opiates
Crack cocaine
Nicotine
Crystal meth
Alcohol

Prevalence of substance abuse:

Alcohol: 10.2% of Americans aged 12 or older have problems with alcohol or are alcoholics.
Nicotine: 8.5% smoke cigarettes.
Marijuana: 5.1% use pot.
Opioids: 1.1% use painkillers containing opioids.
Inhalants: .9% of Americans are addicted to breathing in common household or workplace products.
Cocaine: .5%
Heroin: .3%

Boundaries: How this unusual concept makes efforts to heal substance abuse very, very difficult.

Personal boundaries are subjective: Boundaries are basically the rules for your life. One way to visualize the subject is when someone "invades our space". Perhaps someone literally gets too close to you while talking with you. That person has disregarded your natural boundary. People addicted to substances are particularly adept at surreptitiously ignoring the boundaries of others. It is disturbing when this happens. The phenomenon is not a conscious choice on the addict's part. It is a result of the addiction.

Here is a classic example: A close friend of mine had many problems. She seemed to have a new emergency every week. She would always call and ask for advice and never take it. She was a "needy" person. Someone who is never satisfied. And someone constantly upset about it. She, in essence asked others to rescue her. This is a boundary issue. Her boundaries were broken. You have to end up taking responsibility for yourself. If you are always asking others to save you then you never really learn who you are yourself. You never develop clear boundaries.

Sometimes this kind of behavior becomes so commonplace that we don't question it. For instance: When we get sick, we want a pill to fix it. The latest example of this concerns the weight loss drugs: Instead of healing ourselves by eating less, we want to take a drug that does it for us. This at its foundation damages our personal integrity because we are basically not taking responsibility for ourselves.

What happens with addiction and boundaries? Something significant happens to us when we over-use a substance. Food is a great example: We eat until our body is no longer hungry. That's a natural process. When we keep on eating then we are damaging our body's physical boundary. Basically, we are no longer listening to our body. In fact, we are refusing to listen and intent instead on ignoring messages to stop eating. Eating has gone from a positive experience to a bullying experience. When the body's advice is refuted and rejected consistently over time, the body begins to distrust the eater.

In my opinion, addictive behavior damages the fabric of our body's boundaries. Extensive substance abuse causes more and more disrepair. My close friend who was so needy had severely damaged boundaries over years of excessive drinking. She was an alcoholic. She died of the disease at the age of 51.

One reason this is important is that full recuperation from addiction has to take into account the damage already inflicted on the body's boundaries and take steps to heal that damage. The 12 Step Program is one approach that recognizes this requirement.

Until your spirit heals, the body cannot.

Other examples of boundary injury:

Consistently eating food that you know will cause you trouble.
Choosing relationships which are self damaging.
Voting against your own interests.
Spending money you don't have.

Having strong well sustained boundaries are foundational to good health. Damaged boundaries cause great pain and hurt.

Personality transformation.

Excess substance ingestion consistently over time can have the effect of transforming the personality of the addict: This is partly due to the stress of always having to find more substance to fill the need. But something can happen beyond that that can change a person from being sweet and kind to instead getting easily frustrated and quick to anger.

On a personal note, my sister, who was an alcoholic and sadly passed 35 years ago of cirrhosis, acted strangely the last year of her life. We had no idea she was drinking so much. My family instead thought that she was loosing her mind. That she was having a kind of mental breakdown. Her behavior was confusing and lacking in good sense. Logic had abandoned her. She seemed like she was going crazy. But it was the poisonous effects of the alcohol that produced that personality change, not a psychological collapse.

Addiction and relationships.

Any problems that the addicted person has, other than the addiction, cannot be resolved until the addiction itself is addressed: This phenomenon is pervasive. Many experience frustration and disappointment because of it. There is often a range of problems that an addict has: problems at work, problems arguing at home, difficulty with family. Endless time is spent on trying to solve those other problems and help the person who is addicted. Unfortunately the addiction itself underlies everything else. If the addiction is not addressed directly then failure at solving these other problems is assured.

Addictive qualities of inactivity:

The most common kind of inactivity is sitting for extended periods: It is very bad for our health and well being and I have written about this extensively. But there is something that happens when those older are consistently inactive. It changes the manner in which we live. I often have observed the phenomenon where extended inactivity becomes more profound as people age. We begin to have difficulty walking, problems with balance and suffer an increased likelihood of falls. And to top it off, our personality changes as we become more and more stubborn the less we do. The less we do the less we want to do.

One reason I would call this an addiction is that it is extremely hard to change this pattern. People insist on remaining inactive, even when they understand the consequences.

My perception after teaching thousands of classes in exercise for those older, is that at around in our 70s things shift for us. We start having more physical problems.
Many then believe the idea that those problems are happening because we are getting old and there's nothing we can do about it. We think it is therefore inevitable that we will go down hill.
This is not true. It is a myth: We can actually improve almost all of the issues that challenge us as we age. Especially if we are willing to consistently exercise.
However, many do not listen and instead the inactivity feeds on itself and increases our problems including how we think about our lives.
The stubbornness of inactivity is a sign of its addictiveness.

One solution for substance abuse:

Quitting a substance or behavior cold turkey does not usually work. A more extensive process that addresses deeper issues is required. In particular we have to rebuild our character. We have to redefine our boundaries in a healthy way. And we have to restore our trust in our judgement regarding our body.

I have personally found that the 12 Step Program accomplishes that: Alcoholics Anonymous has helped me greatly. And there are many variations. For example: Overeaters Anonymous, Workaholics Anonymous, Gamblers Anonymous, Emotions Anonymous, Narcotics Anonymous, Marijuana Anonymous, plus as many as 30 others. All have the same structure and general definition of the process. All advocate for a sponsor to help see you through the process. There are religious overtones to the program but in general a "Higher Power" is referred to instead of specific theological terms.

Why does it work? I think this program works for 2 reasons:

It acknowledges the existence of a Higher Power: Some people call this God, or Mohammed or Buddha, or the Virgin Mary. In my opinion, it doesn't matter which. What is important is that we turn our troubles over to something or someone outside of ourselves. This is not asking someone else to rescue you. It is simply placing your troubles in someone else's safekeeping. It is a liberating and deeply relieving realization.
One of the later steps in the process (#9) asks you to take responsibility for past actions that may have hurt or harmed others. It is an effective way to build/repair character.

There is one other type of 12 Step Program which bears specific mentioning: Al-Anon, Alateen and Adult Children of Alcoholics. Many times family or friends are terribly affected by substance abuse behavior. We are drawn into unsolvable problems that are so distressing. We care so much that the situation greatly affects us. The 3 groups mentioned above are designed to assist family and friends of addicts instead of the addicts themselves. Meetings help us understand the reality of the addict and in so doing move everyone closer to a resolution. But they also help us to see the role in which we may be playing in this sad story. Sometimes we cover for the addict or in other ways unknowingly make the situation more complex. Even attending just one meeting of this 12 Step oriented group can generate a miraculous change that can help to resolve the predicament.

My Recommendations:

For the person who is abusing substances: Recovering from addiction does not just mean quitting the substance. You must in some way repair your character as well. There are many approaches that can help. The 12 Step process is one of them.

For those related to the substance abuser: I highly recommend participation in Al-Anon. Your perspective will change and resolution of all issues is far more possible as a result, for the family/friend as well as for the addict.

Obesity

Food As Reward

Age is not the Enemy. Inactivity is.