Getting off drugs, or learning to stop drinking, is very often easier than staying off them. As Mark Twain remarked about tobacco, quitting was easy-he’d done it dozens of times. Relapse, the biological imperative, will have its way with most of those abstaining for the first time. Addiction is a psychological disorder with strongly cued behavioral components, whatever its dimensions as a biochemically-based disease.
The three-headed dragon is a metaphor first popularized by alternative therapists at the Haight Ashbury Free Medical Clinic in San Francisco. The first head of the dragon is physical. Addiction is a chronic illness requiring a lifetime of attention. The second head is psychological. Addiction is a disorder with mental, emotional, and behavioral components. And the third head of the dragon is spiritual. Addiction is an existential state, experienced in isolation from others.
Addicts speak of “chasing the dragon” in an effort to catch the high that they used to achieve so easily. It is also drug slang for the use of small metal pipes to catch and inhale the wisps of smoke from a pile of burning opium, crack, or speed. We can picture the dragon chasing his own tail, snapping at it with all three hungry mouths, in an endless escalation of tolerance and need.
“Because of the unique reaction that the genetically addiction-prone individual experiences to his drug of choice, he or she programs his or her belief system with the deep conviction that the substance is ‘good,’” writes Richard Seymour of the Haight Ashbury Clinic. “This is where self-help becomes intrinsic to recovery. Unless one deals with the third head, unless one changes the belief system and effects a turning-about in the deepest seat of consciousness, there is no recovery.” The “X” factor in recovery, for many people, turns out to be a form of inner self-awareness; something that includes the attributes of will power and determination yet transcends them through a form of surrender.
And speaking of changing one’s belief system, experience has shown that it is a spectacularly bad idea to sit around and do nothing but stare at the wall during the early phase of recovery. Psychologist Mihaly Csikszentmihalyi argues, in The Evolving Self, that when attention wanders, and goal-directed action wanes, the majority of thoughts that come to mind tend to be depressive or sad. (This does not necessarily apply to formal methods of meditation, which cannot be described as states marked by wandering attention.) The reason that the mind turns to negative thoughts under such conditions, he writes, is that such pessimism may be evolutionarily adaptive. “The mind turns to negative possibilities as a compass needle turns to the magnetic pole, because this is the best way, on the average, to anticipate dangerous situations.” In the case of recovering addicts, this anticipation of dangerous situations is known as craving. The next step is often drug-seeking behavior, followed by relapse.
For a highly motivated addict with a stable social life, a safe and effective medication to combat craving might be all that is needed. For many others, however, attention to the other two heads of the dragon is going to be necessary. An addict’s ability to experience pleasure in the normal way has been biochemically impaired. It takes time for the addict’s disordered pleasure system to begin returning to normal, just as it takes time for the physical damage of cigarette smoking to partially repair itself. Alternative therapists are fond of referring to recovery as a process, with an emphasis on the importance of time. Medication of any disease, even if successful, does not treat the continuing need for healing. It is now well understood that mood and outlook can have an effect on healing. Positive emotional states can be beneficial to the maintenance of good health. Thoughtful physicians make the distinction between a disease and an illness. A disease is a chemically identifiable pathological process. An illness, by contrast, is the disease and all that surrounds it-the sociological environment, and the individual psychology of the patient who experiences the disease.
Dissociation
Where does the everyday self go during active cycles addiction? It is not a simple case of amnesia, or sleepwalking. It is more like a waking trance, or autohypnosis. Psychologically, it is a state of dissociation. For addicts, the three-headed dragon is both a part of them and not a part of them. It is integral to who they are, yet it is estranged from their core selves. When activated, the cycle of addiction lead men and women away from their genuine natures. Their sense of self becomes impaired through the processes of intoxication, denial, neuroadaption, withdrawal, and craving. This impaired sense of self causes behavior that is baldly contradictory to their core beliefs and values. Honest men and women will lie and steal in order to get drugs.
Webster’s Unabridged Dictionary defines dissociation, rather vaguely, as “the splitting off of certain mental processes from the main body of consciousness, with varying degrees of autonomy resulting.” Recall that in the case of state-dependent memory, if you give a rat a mind-altering drug, and teach him to run a maze, the rat will perform this maze task more efficiently in subsequent runs if it is under the influence of the same drug. How autonomous were you, consciousness-wise, the last time you got drunk and parked your car somewhere you couldn’t remember?
Dissociation may be part of the way consciousness itself adapts to chronic drug use. Richard S. Sandor, a thoughtful Los Angeles physician, helped to clarify many of these issues in an excellent essay in Parabola magazine:
…the inability to satisfy a physical craving or psychological compulsion will produce all kinds of unusual behavior, but this is true for natural drives and appetites as well as for created ones. What might one not do to avoid starvation? Such behavior alone cannot be used as evidence for a pathological personality type. The failure to recognize this point has led to a considerable amount of confusing retrospective research–deducing a personality type after the addiction had developed. But in fact, a dependence on a substance or activity condemned by society as illegal or immoral leads the addict to act in antisocial ways; and this is the case far more often than that drug addiction results from an antisocial personality type.
Secondly, Sandor points to the inability of prevailing behavioral models to produce a comprehensive framework for effective treatment. “None of the current treatment methods based upon the positivist scientific paradigm-be it psychodynamics (Freud, et al.) or behavioral (Pavlov, Watson, Skinner)-has demonstrated any particular superiority in the treatment of the ‘addictive disorders,’” he writes. “Many psychoanalysts readily admit the uselessness of that method for treating addicted individuals (the patient is regarded as being ‘unanalyzable’).”
Thirdly, says Sandor, “It appears that the most successful means of overcoming serious physical addiction is abstinence-very often supported by participation in one of the twelve-step groups based on the Alcoholics Anonymous model…. The basis of recovery from addiction in these nonprofessional programs is unashamedly spiritual.”
The problem for the addict, as Sandor realizes, is not so much the matter of quitting, as it is the matter of not starting again. The resolve to quit is often present, but the resolve not to start again can be interfered with in a variety of ways. All addictions, Sandor argues, more closely resemble “the whole host of automatisms that we accept as an entirely normal aspect of human behavior than to some monstrous and inexplicable aberration.” Bicycle riding is a good example of an automatism, because once learned, “…it no longer requires the subjective effort of attention; more importantly, once learned, it cannot be forgotten. It is as though the organism says to itself, ‘Riding this thing could be dangerous! It’s much too important to trust that Sandor will pay close attention to it.’”
So what does the mind do? It creates a new state called bicycle riding:
Number one priority in this state (after breathing and a few other things, of course) will be maintaining balance. In much the same way, the organism recognizes that mind- and mood-altering chemicals disturb the equilibrium of functions and are therefore potentially dangerous. In response, it may form a new state in which the ability to function is restored, but in which a new set of priorities exerts an automatic influence. Just as one’s only hope of not riding the bicycle again (if for some reason that is important) is to never again get on one, once a particular addictive state has developed, there is no longer any such things as “one” (drink, hit, fix, roll, etc.). Addicts begin again when they forget this fact (if indeed they have ever learned it) and/or when they become unable to accept the suffering that life brings and choose to escape it without delay. Addictions can be transcended–not eliminated.
Sandor ultimately concluded that “The only modern Western psychologies that can aid us in our search to become truly human are, like AA, frankly spiritual or transformational in nature (e.g., those of Gurdjieff, Jung, Frankl).”
Sandor compares the addictive state to a form of hypnosis accompanied by posthypnotic amnesia. This automatism, this subsequent amnesia about the drugged “I” on the part of the sober “I,” is highly reminiscent of the consequences produced by state-dependent memory:
A hypnotized subject is instructed to imagine that helium-filled balloons are tied to his wrist; slowly the wrist lifts off the arm of the chair. The subject smiles and says, ‘It’s doing it by itself!’ The ‘I’ that lifts the arm is unrecognized (not remembered) by the ‘I’ that imagines the balloons…. One part denies knowledge of what another part does. A cocaine addict, abstinent for a year, sees a small pile of spilled baking soda on a bathroom counter and experiences an overwhelming desire to use the drug again. Who wishes to get high? Who does not?
“Interestingly,” Sandor says, “this type of amnesia is very similar to that seen in the multiple personality disorder (see Jekyll and Hyde), in which one entire ‘personality’ seems to be unaware of the existence of another. Even more interesting is the fact that confabulation, rationalization, and outright denial are also prominent features of the addictive disorders.” Dissociation, then, can occur without the intervention of anything as dramatic as hypnosis. The common quality is automaticity, the experience of “it doing it by itself.”
Archive for September, 2007
The Dragon of Dissociation
September 30, 2007
COPING WITH URGES
September 30, 2007Anyway, on to the article…
Habits and urges go hand in hand. In fact, many people in the throes of an addictive behavior problem, whether it is overeating, drug use or alcohol abuse, claim that they derive no pleasure from their habit–that it is nothing but the relentless craving that fuels ongoing addictive behavior. What is usually most difficult for people when changing a bad habit is coping with the sometimes relentless urges. The initial days of a habit kicking plan can be exhausting as urges dominate thinking and interfere with daily routine. Many people give up change efforts because they feel that there is not way they can function without their habit as the urges interfere too much with quality of life.
It is important to remember that urges, in and of themselves, are normal. We experience craving in varying degrees every day. And because your habit has been important to you for a long time, it may be unreasonable to expect urges to vanish completely. What is hoped is that you will come to experience urges with less frequency and that when they are experienced you will be able to react in a way that avoids relapse.
The “three Ds” can be helpful in coping with urges and craving, whether these urges are related to alcohol or drug use, overeating , tobacco use or any habit you are attempting to change. The Ds stand for Decatastrophizing, Disputing Expectancies and Distracting.
Decatastrophizing
Especially early on in your change efforts, craving can seem excruciating. Your daily routine has been altered by the elimination of an important part of life and now you can’t get your mind off it. Everything you see reminds you of your habit. If you smoke, every room you enter may bring to mind the image of a cigarette and associated pleasure. The inability to satisfy the urge can lead to frustration and inner statements like, “I can’t stand this!” or “There is no way I will be able to live without giving in. I’ll just go crazy!” Statements like this can be overwhelming. So much so that people often give up efforts.As is the case with anxiety, catastrophic thoughts can lead to a great deal of arousal which can, in turn, make things seem worse than they are. If you believe that you are completely out of control, your emotions will follow. What is important to remember is that urges are normal and typically decline in intensity as you continue implementing change. To combat catastrophic reactions to urges it is important to remind yourself of times in the past when you have successfully changed habits (think now, we all have done so at least once or twice!). Do you still experience urges? If so, are they as intense as during the initial phase of your change efforts? Probably not, right? Furthermore, think about other people you have known who have undergone significant change. Do they seem haunted by urges such that they cannot function? If not, who is to say that you cannot accomplish that also?
Try to take some of the power away from a black and white adjective like “horrible” or “unbearable.” Belief in horrible extremes only makes you feel worse. Just how unbearable is your urge right now? To accurately answer this you may need to conjure images of what other types of suffering reported as unbearable are like. Is this as unbearable as getting stabbed in the stomach? Or better still, what have you endured which was worse than your current urge? Was that unbearable? If so, does it follow that your urge is less than unbearable and perhaps only “very uncomfortable.”
Disputing Expectancies
Craving is, in essence, the activation of expectancies. Beck and his colleagues (Cognitive Therapy of Substance Abuse, 1993, Guilford Publications) believe that there are three beliefs associated with “the acute decision to engage in substance abuse.” They are Anticipatory, such as “I’m gonna be Mr. Wonderful after one line.” Relief Oriented, such as “I won’t have to think about work if I drink this bottle of wine.” and Facilitative or Permissive, such as , ” I’ve been good all week, I’m entitled to an evening high.” Though Beck and his colleagues presented these fundamental beliefs in reference to substance abuse problems, it is this author’s contention that these beliefs can function in any habit urge.Since we rarely think about distant consequences when craving, bring them to mind deliberately. Bring to mind the negative emotions which may be experienced at a later time due to engaging in your habit. Urges are “myopic” in that they can only see advantages. You must shed some light on your craving in order to effectively control it. Ask yourself questions like:
* How will I feel later if I give in to my urges?”
* What consequences might I suffer if I give in?”
* Will the negatives outweigh the positives in the long run if I give in?”Another way to cope with urges is to imagine that someone very close to you is voicing the very urge you are experiencing. How would you go about convincing them not go give in. Sometimes distancing ourselves from our urges is imperative before you can subject them to any scrutiny.
Your ability to conjure vivid images can be used in your favor when you experience craving. In the presence of a strong urge, try to imagine a very negative outcome. The more negatively graphic the better. The more true to your life the better. For example, if you have a problem with alcohol and experience a strong urge to walk down to the convince store and buy a bottle of Vodka, imagine the worst hangover possible. Imagine vomiting all morning. Better still–imagine someone very important dropping by, someone you really want to impress, and seeing you in that condition. It is amazing how powerful our own imagination can be in fueling and impeding behavior. Use it to your advantage in your habit change efforts!
Distracting
Some urges are so relentless that talking back to them is insufficient. You still can’t get your mind off your habit. Good old fashioned distraction is sometimes the only medicine that can pull your thoughts away. Distraction can be cognitive, in the form of some mental exercises, or behavioral, in the form of activity. Certainly the latter is going to be the most effective, in that urges tend to occur in environments with are the same or similar to those in which the habit occurred in the past. If you are trying to quit smoking, and you have previously smoked at in your office all day, being in your office is going to elicit a strong drive to light up. Certainly if possible, taking your work into a conference room, or taking a break and walking outside will often be enough to decrease the urge to a manageable level. You must evaluate your schedule and determine which situations evoke the most intense craving and create as much flexibility as possible so that you can “escape” if necessary–especially in the initial days of your change efforts.Cognitive distraction can be very powerful. Certainly imagery has been used as a means of helping stressed people learn to relax. You too can use imagery to take your mind off an urge which is dominating consciousness. Conjuring a pleasant place like a beach or on a raft in a lake can help you not only take your mind off the urge but relax as well.
However, “relaxing” images are not helpful for everyone. Some find that if they relax when craving they will only want it more. This makes sense as we have discussed that many habits are associated with relaxation and pleasure, and evoking these feelings in places previously associated with your habit can strengthen urges tremendously. I recommend that you find some mental task that will be very difficult to finish but which is interesting and consuming that you can activate in response to an urge. I like to refer to these as Mental Tapes. Some examples of tapes which have been helpful are:
* Writing the perfect epic novel or screenplay.
* Planning the perfect vacation.
* Creating the ideal money-making business
* Interpreting a dream from the night before
* Picking an acquaintance and trying to “figure them out.”Certainly what you choose will depend on your interests, but the key is to make it something that will be easy and perhaps interesting and fun to do. Choosing to think about all the mistakes you’ve made this year and how you could have done things differently is not going to prove a good distraction tape as it won’t be enjoyable. In fact it may increase the power of your urge, especially if stress has precipitated your habit in the past.
It is sometimes best to try one urge control technique at a time so that you don’t get overwhelmed. These techniques work, but they also require a great deal of mental energy and conscious effort. The aim here is not to make change excruciating or extraordinarily taxing, but to provide you with some tools which you can add to your armory at a your own pace.
Robert Westermeyer, Ph.D.
Girls and Drugs
September 30, 2007Just the Facts - Girls and Drugs – Parents – The Anti-Drug
Consequences of Drug UseAdolescent girls are susceptible to the physical, mental, and sometimes social consequences of substance abuse, especially at a critical time in life when their bodies and brains are still developing.* Some research shows that marijuana use can precede symptoms of depression. Girls (ages 14-15) who used marijuana daily were five times more likely to face depression at age 21. Daily use in young women was associated with an over fivefold increase in the odds of reporting a state of depression and anxiety. (Patton et al., 2002)
* Girls are more vulnerable to the health consequences of substance use, such as developing symptoms of nicotine addiction faster than boys. (DiFranza et al., 2002)
* Adolescent girls who consume even moderate amounts of alcohol may experience disrupted growth and puberty. (National Institute on Alcohol Abuse and Alcoholism, 2004)
* A recent study concluded that engaging in sex and using drugs places adolescents, and especially girls, at risk for future depression. (Hallfors et al, 2005)
* It is estimated that teenage girls who binge drink are up to 63 percent more likely to become teen mothers. (Dee, 2001)
* In 2003, approximately one out of four (23.9%) sexually active ninth-grade girls had used alcohol or drugs during their last sexual intercourse. (YRBSS, 2003)
Deeper and Deeper
September 27, 2007Well, after barely enduring the past 48 hours, I certainly have a new found respect for methadone that’s for bloody sure. Maybe respect is not the most accurate description, but I do know that this will be the first and last time that I’ll ever take my MMT for granted. I see now how easily I’ve allowed myself to become complacent about my treatment. Never again I say!
For the first time since I’ve returned to MMT, I missed going to the clinic to get my scheduled dose. Circumstances were such that I just could not make it there yesterday. I honestly thought that it really wouldn’t be much of a deal as I’m only on 80ml and have been taking my dose since February of last year as well as been stabilized on this dose for the last nine months or so. I had taken my dose on Tuesday at approx 1pm and figured that I would be fine until this morning at 10am.
I got through the majority of yesterday without incident. Work was fine. I noticed in the afternoon that my stomach was unusually unsettled and that I had a few uncontrollable sneezing bouts, but I simply put this down to picking something up from the kids, as Sara had been complaining since the weekend of being really congested, plus having a sore throat. By about ten last night though I started to really feel like crap.
My stomach was still unsettled and my nose was running constantly, plus my body started to ache all over and my head was pounding. Great, I thought. As it had been what seemed like a near eternity since I had been dopesick, I’d allowed myself to become somewhat cavalier about the whole thing. How soon, and easily, we (can) forget. As there wasn’t really a whole lot that I could do at this point, I basically decided that probably the best thing for me to do was to try to sleep through this whole ordeal, so that when I woke up in the morning, the first thing I’d do was drag my sorry ass to the clinic.
It has now been an hour and twenty minutes since I took my methadone and miracle of miracles, I feel just fine. My stomach is no longer bothering me, although now I feel absolutely ravenous, plus I’ve stopped sneezing and my nose is no longer running. Soon I imagine, the last of my body’s aches will also disappear.
Obviously this illustrates what a powerful tool methadone can be in our fight against addiction. It sure is no lightweight. And yes, this also illustrates how addictive the solution to the problem can be and how yes, we may just be trading one evil for another with no great improvement ultimately in our “prison sentence”. So what’s an addict to do?
For me personally, I know that MMT is the best solution. Where I live, suboxone has not yet been approved so it can not yet be legally prescribed. Cold turkey is for the birds, literally! A decade ago, I spent just over two years on MMT and was able to stop it by gradually tapering down my dose. Once I had reached about 15ml, I just stopped taking it and except for about seven to ten days of mild discomfort, I didn’t suffer much at all. All of my cravings by this point had also been eliminated. For another three years, I continued to remain opiate – and methadone – free. Going back to them is a story for another day.
Obviously I’m not yet in a comfortable enough place to even consider weaning myself off of this treatment but I also know that I’m not necessarily condemned to a life sentence although, if worse came to worse and I was, I’d eventually find a way to deal. Right now, all that I know is that I don’t ever want to feel even remotely dopesick again if I don’t have to.
I’ll not be so cavalier in the future either, because at the end of the day, its also bigger than simply feeling dopesick. Obviously, my mood would end up affecting my family and my work, and not in a positive way. I’ve made far too much progress in the past year and a half anyway to mess it up. I’m also glad that I rode out the sickness rather than taking the easy way out by medicating with some other type of opiate. Let me tell you that around 4:30am this was a real possibility that I’m glad I didn’t follow through with.
Angel of the Morning
September 26, 2007All things considering. my teenage daughter and I have a fairly fantastic relationship. I trust her judgment for the most part and feel that she is quite mature for her age. I respect most of her decisions and do my best to be supportive of her endeavors. There certainly have been times when I’ve had unilaterally veto one of her plans but this is the exception rather than the rule.
Now all of this being said, sometimes I find her behavior is more than enough to drive me completely, absolutely certifiably insane. It always seems like it is the little things that end up pushing me over the edge also. Yesterday evening and today would be classic Sara – and Katie – stuff. Before they were able to do anything yesterday, they had to pick up the massive pile of clothes that had been growing on their bedroom floor for the past week and a half. Combined with the clothes was an odd assortment of other crap, so much so that one could no longer see their carpet. I felt that this was a more than reasonable request.
Mary Jane Meets Charlie and they are Never the Same Again
September 20, 2007Most of this entry was written over two years ago but feel that it is pretty relevant to the present day as most of you don’t yet know me and many don’t often have the time to wade through each and every journal’s archives. Figured that now was a good a time as any to share with you some of my history! My weakness is and always has been anything that is part of the opioid family. Up until that first hit, I had been somewhat indifferent towards drugs but the moment that first dilaudid entered my system, I knew that it was pretty much all over for me. I had found my Achilles heal although at that time, I had no idea what a roller coaster ride I was about to begin.
I actually never even tried drugs until I was almost twenty-one. Through high school, I was more of a drinker. My brother who is a couple of years younger than I am began experimenting at the ripe age of 12 and I watched in absolute terror what he was doing and did to his young body. I also did not want to add to the anguish that my parents endured as my brother navigated thru his teen years. I just couldn’t added to that
So I kind of made a casual commitment to myself that I could wait to try plus in all honesty, it didn’t look like a whole lot of fun watching my brother puke, stagger, dribble down his clothes, pass out, you name it. I can’t remember how many times my boyfriend or myself or both rescued my brother from mess after mess after mess. Believe me nothing about his behavior was remotely attractive and as a result I never felt as if I missed out on anything. Now in hindsight I am kind of glad that I never used anything as a teenager because my brain cells were pretty much left untouched during their crucial growth period.
For my first year of university there were no situations that I found myself in to have a chance to try anything other than liquor. Again never felt as if I was missing anything. Finally in my second year, I decided that I wasn’t going to lifeguard. Instead, I wanted to give waitressing a try because I felt I had a greater chance of making much more money while working less hours. I found a place to hire me as a cocktail server and this place just happened to be the place to go every Thursday, Friday and Saturday way back then. I made money hand over fist and I started meeting some very interesting and experienced people – both fellow staff members and customers. Lord when I think back to my second year, I was so utterly out of my depth and so very green. I started going to the parties after the bars closed and finally I was standing around with a group when someone passed a joint around. I carefully watched everyone and when it was my turn, I believe that I carried it off like a pro. Once people had seen me take some form, any form, they became much more open and inviting with me.
The next party I find myself being invited into one of the three bedrooms with a couple of other people. When I get in there, there are about a dozen lines of this white powder lined up in a row and a guy sitting behind the table. He says help yourself to us with the qualification that it will cost us $10 a line. I had never seen cocaine until that moment and to be honest, I didn’t really have any idea what it actually was and what it would do…Drum roll…Of course, I ponied up my money and waited my turn. Again I paid close attention to what the others before me did and when it was my turn, I flipped my hair over my shoulder so that it fell down my back out of the way of this precious powder. Inhale and away I went. It was the coolest. Oh my goodness, I felt amazing. I was amazing. I was no longer little shy me from no name town population 1500. I had arrived and what an arrival it was!!!
My second year at university was coming to an end and I was getting ready to spend the summer in the British Isles with my best friend. About a month before we were to leave, I got involved with one of the bouncers at work. He was a very bad boy and I found him so utterly exciting. He just oozed danger and I was ripe for the picking…
TO BE CONTINUED…MUSHROOMS, ACID AND THE RINGING IN MY EARS
A Day Late…
September 10, 2007Sounds simply marvelous to me. Our training period is more or less complete now also. We both feel more than comfortable in our new positions as well as working within the confines of this company, our employer. For September, we had nineteen units vacate plus twenty one move in. This was all done over a five day period for the most part too, which meant a near week of sleepless nights as the units that were vacating had to be made ready for the new tenants. Now by made ready I mean that they all had to be painted, carpets steam cleaned or replaced plus the unit had to be thoroughly cleaned. They all had to be made to appear brand spanking new just like a virgin!
Now I’ve just got to tidy up all of the paperwork related to the new tenants and address some minor issues here and there from some of the units and I’ll be all done. Sweet. Can’t wait to be able to really sit down to my computer and get caught up with all of the journals that I read as well as make this one a little bit more current. Looks like I’ll have loads of time soon as for October I’ve just got two units to worry about – not twenty one!
