Addict

What Is Cross-Addiction? Why Can’t A Pill Addict Drink?

One of the more common questions around treatment centers and the recovery fellowships goes something like,”I’m addicted to prescription drugs, not alcohol, so why can’t I have a drink?  What's this cross-addiction I've heard about?”

That’s really not an unreasonable question. Why do addicts who don’t seem to have problems with alcohol need to stay away from it anyway? Why can’t a prescription drug addict have a few drinks?

There are really two reasons:

  • Alcohol reduces our inhibitions and increases the likelihood that we will make bad choices; and
  • Just as they say in the rooms, “A drug is a drug is a drug.”

Number one is pretty much self-explanatory, and can be attested to by anyone who has regretted something he or she did while they were drinking. The parts of our brains that are responsible for taking in information and allowing us to make reasoned decisions are among the first functions to be depressed by alcohol, along with some motor skills. (See any relationship to drunk driving problems there?)

We make poor decisions about driving, about kissing the boss’s wife at the Christmas party, about arguing with large men who carry guns and handcuffs, and all sorts of other things, including whether or not to drink more or use other drugs. “It seemed like a good idea at the time” can become a major problem when we’ve had a couple of drinks. Essentially, booze makes us dumber while convincing us that we’re smarter.

The second reason, known as cross-addiction, is a bit more complicated but makes perfect sense when you understand a few things. Cross-addiction refers to how we addicts, once addicted, are far more likely to get hooked on other drugs or behavior in addition to our drugs of choice.

Why do we drink or use drugs? We may say we like the taste of whiskey, but the fact is that we like it because we associate it with the way alcohol makes us feel. We use alcohol and other drugs because they change the way we feel. They make us feel “good,” or they “relax” us, or they (insert own reason here). Sometimes we use because we’re happy and we want to feel happier, but most of us use drugs and mood-altering behavior because they distract us from reality. Trouble is, the drugs always wear off, and we’re always there, wishing we still felt good. It doesn’t take us long to figure out how to make that happen.

Certain activities stimulate the production of chemicals in the brain that make us feel pleasure. Generally, these relate to things that are mostly beneficial: seeing a loved one or good friend, eating, exercising, playing games — especially if we win — fun, daydreaming, getting a good grade in school, a compliment, sex and so forth. They are quite literally our bodies’ way of insuring that we keep on doing things that are good for us. We refer to the portion of the brain that is stimulated as the reward center.

Alcohol and other drugs also stimulate the reward center, and they do it extremely well to begin with. When we start drinking and using drugs, the feelings are phenomenal. They are much stronger than the normal sorts of feelings, because the drug causes the production of extra quantities of feel-good neurotransmitters or, in some cases, stimulates the receptor sites in the reward center directly. Now that’s a reward, we think (sort of) — a powerful reward for using the drugs instead of our natural system of feeling good. Doing it again seems like a very good idea indeed.

But the goodness doesn’t last. As our reward centers become accustomed to the higher levels of stimulation, they become pretty much immune to the natural reward chemistry. We begin to need chemicals in order to get any sense of pleasure, and eventually just to feel normal. As we increase the levels of drugs, our brain attempts to compensate for the high levels of stimulation in two general ways: first by reducing the production of the natural feel-good chemicals, and also by building new receptor sites to deal with the excess chemicals floating around. It does this in an attempt to keep things to something like normal, but it’s doomed to lose the contest. Eventually, we have to have the drugs in order to function at all. We’re — guess what — addicted.

Now some of you are going to think, “Man, they oversimplified that big time!”, and you’ll be right. Others are going to think, “What crap! I drink…use drugs…whatever…because I want to!” Well, if you only have have a couple of whatevers a week you may be right, but if you’re reading this because you think you might have a problem, you’re wrong and you’d best pay attention.

So what does all this have to do with a prescription addict having a drink? Everything. At the end of the day all drugs, including alcohol, act on the reward center. We get our good feelings from the reward center, and the reward center doesn’t know the difference between one drug and another. We can tell the difference in our conscious mind, because we feel the physical changes in other parts of our brains — stimulation, depression, whatever those effects may be — but the reason we enjoy them is because of the effects on our reward center, which operates mostly below the conscious level. Really now, who would want to get all jittery…or dumb and sleepy…or stupid and hungry if it didn’t feel good?

So, when we take a drink, our reward center is like, “Hello? This feels good, and we know how to make it feel even better, don’t we?” If we’re in early recovery — the first two years or so, say — our brain hasn’t even gotten back to normal yet. It has to deactivate all those extra receptor sites that it created to handle the extra stimulation, and it also has to have time to reactivate the systems that make the natural neurotransmitters. During that time we’re sitting ducks for relapse. Even after the repairs, the receptors are still there waiting to be reactivated by the presence of the drugs. We’re talking repairs here, not new brains.

Any mood-altering drug or activity can affect the reward center, and so any of them can become addictions. Cross-addiction normally refers to substances, but it can also apply to behavior.
People often replace alcohol and other drugs with mood-altering activities like gambling, which is especially dangerous because of all the booze and drugs around (they know it makes people stupid). Other behaviors include relationships, porn, other sexual acting out, exercise, thrill-seeking and other activities that heavily stimulate the reward center. The fact is, you can get addicted to almost anything, if it causes pleasure or distraction from life issues.

That means that the name of the game in recovery is avoidance of all mood-altering substances — okay, not caffeine (in reasonable quantities) — and excess in other areas of our lives. Fun is fine. Pleasure is fine. But when the feelings become the reason for what we’re doing, to the exclusion of the activity itself and the people involved, we are headed for trouble.

The aim of recovery is not eliminating fun, it’s moderating our behavior and learning to live without mood-altering in unnatural ways. Four generations of alcoholics and addicts have demonstrated millions of time that it’s the most reliable way to remain clean. Until someone comes up with something better (and our bet is that it will be a long time) abstinence and a good program of recovery are the best, if not the only, way to go.

Complete Honesty In Step 4 Is Difficult The First Time

This is going to offend some folks, and that’s the point.

Over the years, I’ve spoken with alcoholics and other addicts who have done three and four 4th Steps, and (presumably) a 5th and 6th along with them. I’ve also talked with others who have adamantly stated that they did their 4th Step, cleaned house, and that’s it, that The Book doesn’t say anything about doing it more than once, and The Book is the way they work their program.

Without wanting to seem confrontational, that’s pure b.s. Honesty in Step 4, especially, is nearly impossible in early recovery and The Book doesn't say we shouldn't repeat it, either.  When Bill Wilson wrote the book Alcoholics Anonymous three-quarters of a century ago, there was a boatload of things that he left out simply because no one had thought of them yet. Bill followed up the Big Book with several others that expanded on his thinking, but some folks seem to believe that all essential knowledge about addiction reached its peak in 1938-39. And, let’s be honest, the basic texts of virtually all the other fellowships rely so heavily on the Big Book that they’re practically interchangeable except for the adjectives and a few nouns, so it’s easy to carry that thinking over to those fellowships as well.

Fast-forward 70-odd years, and we know incomparably more about alcoholism and other addictions than Bill ever thought of. For example, there’s a superb article in last week’s edition of The Fix, CBT and the 12 Steps Have a Lot in Common, that compares the Twelve Steps to Cognitive-Behavioral Therapy (CBT).  It establishes in one more way the validity of the Steps as they compare to modern knowledge and theory, and also confirms (once again) Bill Wilson's brilliance.

I recommend the article, but it’s not the point of this one. The real point is that in the first stages of sobriety we aren't able to face and/or talk about all of our issues. Our fragile self-image, just beginning to emerge from the shame of our primary addiction(s), can’t take any more battering, and we’re extremely likely to sweep a lot of stuff back under the pantry door instead of finishing the job of cleaning the kitchen. We aren't able to be completely honest with ourselves, let alone with someone we've known for only a few months, no matter how sincerely we try.

So how can we trust a process we went through in the first few months of our recovery, and truly believe that we've done a good job with that initial inventory? The answer is our old demon, denial. We want to believe that we’re finally okay, and we are afraid to face the facts that mean we are not, that ignore issues that we've failed to address, and that are still screwing up our lives.

My drug of choice was alcohol (not that I didn’t sample many others over 20+ years of active substance addiction) and I was also addicted to some prescription drugs. Fortunately, circumstances in my life precluded easy access to illegal drugs, or undoubtedly I would have been hooked on some of those too. In any case, booze brought me to my knees, and that and the surrounding issues are what I dealt with during my step work. There was enough chaos connected with alcohol that it was easy to ignore some other things that were, in their way, creating dysfunction just as powerful if much less obvious. I’m still working on some of those, many years after that initial step work.

Nicotine, shopping, sex, codependency, gambling, energy drinks, eating disorders of any kind, hoarding, collecting carried to ridiculous extremes, video games (again, to excess), over-exercising — anything that will allow us to distract ourselves and that will give us that brief rush of feel-good brain chemicals — are disorders of our brains’ reward response. They make us feel better, while allowing us to ignore for a bit the normal problems of life that we haven’t learned to face. The trouble is, the good feelings don’t last and we’re so confused we don’t know or remember how to look for them in places less harmful.  Our unhealthy attempts to avoid the normal unpleasantries and pain of life simply increase, along with our dysfunction, until we are in some way forced to contemplate change.

So I put it to you this way, my fellow addicts: If we think we have nothing to deal with but our substance abuse, the chances are we’re fooling ourselves. Until we become willing to revisit Steps 4, 5 and 6, whether in the rooms or with a good therapist who understands addiction, we may be hopping through life on one lame leg, thinking we're just fine. And that kind of movement through life is not only uncomfortable, it also makes us far more likely to fall under a bus.

“Sought Through Prayer And Meditation”

The Eleventh Step reads, “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”

Since I believe that one’s relationship (or not) with a higher power is private, and that in the context of the rooms of recovery it verges on being an outside issue, I won't be getting into it here. However, there is no question that the meditation part is critical to healthy emotional growth for alcoholics and other addicts, and that it’s important for the population at large, as well. (See the preceding link) That being the case, and because meditation has gotten a bad rap from folks who think it’s tedious and difficult, I thought I’d hit some of the high points about how to meditate.

In a sense, meditation is planned boredom. We purposely put ourselves into a situation where we have no choice but to live with our thoughts. This was common a half-century ago and more, because life contained far fewer ways of filling up time with relatively unnecessary things. By that, I mean things that don’t increase our quality of life, but that simply fill up empty time that could more profitably be spent in — boredom.

Human beings need these periods. Our days are filled with things that take up our time, but that do nothing to uplift us. Those of us who have been able to slow our brains down and spend a couple of 20 minute periods a day in meditation have found that if we do so regularly, things just seem to get better. During those periods, we seem somehow to fit the irregular pieces of our lives together a bit more smoothly.

RoadHave you ever driven several miles, only to realize that you remembered nothing about the trip — not only the trip, but what you might have been thinking, the songs that played on the radio — nothing? Have you ever come to with a start, and realized that you had lost a few minutes? Have you ever been so deeply engrossed in reading a book, or listening to music, that you were oblivious to everything going on around you for several minutes — even hours? If you have had any of these experiences, you have been in a meditative state. Whether we call it hyper-focusing, daydreaming, or “lost in thought,” it’s all the same thing.  In our fast-moving world we have come to think of these periods as wasting time, when in fact they are probably the most important parts of our day in terms of emotional health and general wellbeing.

We are naturals at meditation, and since we already know how, the idea of doing so regularly may seem less of an ordeal. It really isn’t difficult, although it may require a bit of patience and acceptance to begin with.  We only have to learn to do on demand what we already know how to do unconsciously.

That is surprisingly simple. We simply remove other distractions. We find a quiet place, indoors or outdoors (outdoors is best). We desert our phones, iPods, books, lists and the other things that tyrannize our day — including the other people in our lives. We sit quietly.

Then we simply let our mind wander. If we find it focusing on problems, chores, ideas for new projects, our love life or other specifics, we acknowledge their presence and then let them drift away. We don’t dwell on them. If they come back, we say, “Okay, there it is again,” and we let it go.

After while, we will drift into what amounts to a daydream, where we are no longer conscious of trying, our minds wandering where they will. That is meditation. We are not working at thinking about specific things. Quite the opposite; we are giving our minds a chance to function a bit on their own, undirected, and able to exercise themselves without interference from us.

It takes a bit of practice to reach a point where we can do this more-or-less on command. Most folks find that about fifteen to twenty minutes a couple of times a day can work wonders, once we get the knack of it. Just remember that meditation is for its own sake. It has no specific purpose. If we start looking for one, we’re approaching it wrong.

Try it for a couple of weeks, then keep on if you find it rewarding. My guess is that you’ll be online buying meditation supplies (that you really don’t need) before you know it.

Let’s Not Take Boston To Chicago

I know I speak for the entire Sunrise family when I extend our deepest concerns and sympathy to the victims, families and others whose lives have been devastated by yesterday's awful tragedies at the Boston Marathon and nearby.  We have friends, colleagues and former clients in the Boston area, and some of us have family there as well.  Words can't express our dismay at these events — one more example of folks' inability to resolve differences without violence.

Ron P., one of my therapists when I was in treatment (you know, back when everyone was eating fermented fruit that they picked up on the way to the water hole), used to have a favorite way of putting things.  He'd ask a simple question, or be listening to someone going on at length in group, and then he'd say, “C'mon!  You're taking it to Chicago!”  Then he'd bring us back to the point or, as often as not, make it for us.

I couldn't help thinking of Ron while reading snippets here and there about the Boston bombings.  One theorist blames the US Government, who are allegedly trying to frame the opposite political party.  Still others are sure they know who and what ethnic groups were responsible, and so on.  Blah, blah, blah.

The bare fact is, no one knows who was responsible except for the people directly involved.  It is likely that the rest of us will know more soon, but it's by no means certain, and it's important that we keep our heads and not jump on our horse and ride off in all directions like the codependent cowboy.  It's especially important that we keep these issues out of the rooms of recovery.

We all have our feelings, and many of us aren't that good at keeping them to ourselves.  If we feel as though we need to talk about things, we need to remember the first rule of sharing in the rooms or elsewhere: keep in in “the I.”  We share about how these things are affecting us and our recovery.  We do not voice opinions on outside issues, in violation of our traditions, and we don't take a chance of offending others in the meeting.  We are not there to ride a political (or religious) hobby horse, but to facilitate our recovery, and that of others.

Let's keep our primary purpose in mind, when tempted to air the opinions that all us addicts have in abundance, shall we?  As a bonus, it may prevent us from having to eat crow later, when our pet theory may be shown to be incorrect.  Let's not take Boston to Chicago.

 

Antidepressants In Recovery — Just Another Drug?

Depression is not uncommon in the first year or so of recovery. Some people manage to avoid it entirely, but many of us experience it to one degree or another. That’s because sometimes the ability of our brains to produce the chemicals that make us feel good has been damaged by the alcohol and other drugs, and it takes time for the necessary repairs to take place.

Unfortunately for many of us, the drugs that we used masked underlying problems.  For example, roughly 65% of alcoholics are known to suffer from pre-existing emotional problems, most of them brought about by imbalances in brain chemistry.  Those folks usually find that the removal of the drugs brings out the underlying conditions, often severely so.  Thus, the idea that all we have to do is stop drinking and straighten up is often — sometimes tragically — not the case at all.

Whatever the case, if we end up feeling that we’re worthless, that life is not worth living, and that it’s just not worth the effort, that’s bad. Depression kills people every day — far more than it should, because in most cases it’s treatable.  The problem is that, in some cases, it worsens so rapidly that the time to begin effective treatment can be quite short, so it doesn't pay to wait around.  If you're feeling depressed to the point of not caring about your life, see a doctor.  Right now!  If you're having thoughts — even casual — of self-harm, then you're already in crisis.

Many folks have been on antidepressants, felt that they didn’t work, and stopped taking them. Most antidepressants take from three to eight weeks to have their full effect, and sometimes in the early treatment period they seem to have no effect at all. Combine that with an addict’s conviction that taking a pill should make us feel good right now, and you have a good chance that the patient is going off the meds before they have a chance to help.  Others have found relief, and stop because they believe they're cured.  AD's are not like antibiotics.  They cure nothing, they simply reduce the effects of the depression and allow us to function.

Not all antidepressants work for all patients, and if we toss one before it has a chance to work, we run the risk of missing the one that was right for us. Second, and perhaps more important, is the fact that sometimes the medication was beginning to work and we just didn’t notice. In that case, if we quit suddenly, we can experience a rebound effect that throws us straight into deep depression.

This brings us to the big point we’d like to make here. Depression is nothing to fool with! There is an unfortunate attitude among some of the laypeople in the recovering community that antidepressant medications are just another drug. That is emphatically not true!

Antidepressants (ADs) are not the sorts of drugs that most recovering people mean when they say drugs. They are not addictive, in the sense of creating tolerance and cravings for more. They will not interfere with recovery by preventing our bodies and brains from repairing themselves — in fact, they assist in the process. They do not alter our mood, except for the better, and they do not interfere with our judgement. They do not trigger the addictive process, and they do not make our lives unmanageable.  Quite the opposite: antidepressants in recovery can lift the weight of the world off our shoulders, and contribute to our recovery by giving us the ability to be enthusiastic about it and enjoy its rewards.

The greatest danger of antidepressants is the danger of not taking them when we need to. Depression can not only lead to self-harm in its more severe forms, it can keep us from seeing the gains we are making in recovery, putting us at increased risk of relapse.

That said, there are some downsides. In some people, ADs affect the ability to feel and express emotion. Some have other side effects that can vary with the particular medication. However, none of these are as dangerous as suicidal thoughts or acting out, or as harmful to recovery as a relapse because “Life sucks, so I might as well just use.” And, as mentioned earlier, going off an antidepressant without a physician’s guidance can have devastating results. Any undesirable side effects should be discussed with a physician.  It may be necessary to change a dosage, or switch drugs, but do not stop on your own!

We're not recommending that recovering folks run out and look for a doctor who will prescribe antidepressants, nor are we offering them up as some sort of magic pill. What we are trying to get across is that we need to listen to the experts, and we need to be careful about making medical decisions that we aren’t qualified to make.

For some of us, antidepressants in recovery can be a tool, but they are not the whole answer. The answer, as always, comes from remaining abstinent and learning how to live without addictive drugs through therapy, support groups, and an organized program of recovery, but it makes sense to utilize all the tools if we need them, especially if failure to do so can kill us.

Important Note: This article should not be taken as, nor is it offered as medical advice. You should consult with your personal physician or a specialist, as appropriate, before considering the use of, or ceasing the use of, any medication.

It’s Okay Not To Feel Okay

We addicts are delicate folks. Things that other people shrug off hit us deep in the gut and stay there. Discomforts that other people find annoying are major issues. An off-the-cuff remark becomes a long-term resentment, minor aches and pains a medical catastrophe, and heaven help us if we have real issues to deal with!

We were people who didn't know that it’s okay not to feel okay, and we knew just what to do about it. We chased okay around casinos, crack houses, malls and singles bars, shooting galleries, sleazy hotels and online porn sites, and into and out the other side of all sorts of jackpots. We messed up our lives and those of bystanders (innocent and not-so-innocent), and we finally reached a point that the alcohol, other drugs, sex, shopping, football pools and what have you no longer did it for us. In the end, we were unable to believe that we were okay, even for a few minutes, no matter what we did.

That’s what got us into recovery: the realization, momentary though it may have been, that if we didn’t get clean and sober we had no chance of feeling okay, ever again.

Then we discovered that early recovery is, to a considerable degree, a lot of not feeling okay. We had to deal with the aspects of day to day living without the cushion of alcohol, drugs and other feel-good behavior. Accustomed to easy, quick answers to troubled feelings, and to easy obliteration of them when we couldn’t find the answers, we found ourselves bewildered when things in our lives didn’t get better right away. Personalities used to popping a pill, downing a couple of beers, hitting the slots or the mall or the back streets suddenly had to face real feelings, and life on life’s terms. At one time or another in early recovery, every single one of us thought that sucked.

But if we stuck with our programs of recovery, we got over it. We came to understand that the changes we made in our view of the world and others by our use of artificial ways of coping with feelings had caused, or were the results of, personalities that needed readjustment. It eventually got through our addled senses that we couldn’t expect bodies — especially our brains — that had been changed by the presence of those artificial ways of coping to get back to normal right away, either. It finally occurred to us that the days of buying answers were over, and that we needed to learn how to live a new way of life without covering up emotions artificially. We took suggestions, and we learned to work through the things that we used to use over. Slowly, we learned how to live without using, and to enjoy it.

Those of us who made those changes in our worldview, who learned that it’s a normal part of being a human not to feel okay sometimes, stayed clean. We learned that it's okay not to feel okay.  We found that feeling okay only part of the time worked just fine for us, because gradually the problems that we were trying to solve with drugs, booze and other behavior just seemed to sort of fade away — and that, sometimes, we were just plain happy, often for no particular reason.

The folks who were afraid to do the work…well, we don’t see them around much any more. And every single one of us thinks that sucks.

Caffeine In Early Recovery

coffeeOccasionally someone asks if they should give up coffee when they get clean and sober, since caffeine is “just another drug.”

Although some treatment centers recommend going caffeine-free, and some replace “regular” with decaffeinated, it’s beginning to seem more and more like that isn’t necessarily a good idea. If something isn’t making our lives unmanageable, it can usually wait until we’ve been in recovery for awhile.

In any case, there is a broad range of beneficial effects from consumption of caffeine, including increases in the levels of neurotransmitters such as norepinephrine, acetylcholine, dopamine, serotonin, epinephrine and glutamate. Many of the symptoms of withdrawal and post-acute withdrawal are associated with low levels of these chemicals, so there is good reason to think that the benefits of drinking coffee in early recovery may offset the disadvantages, which include shakiness and insomnia, among others.

Recent research has also shown that the antioxidants in coffee, along with the antioxidant effects of caffeine itself, benefit long-term coffee-drinkers by destroying free radicals in the body that are associated with heart disease and Alzheimer's.

Please keep in mind that we are referring to reasonable levels of consumption. More than 300 mg. of caffeine (one Starbucks Pike Place brewed) within three or four hours can cause anxiety, and even one cup of brewed coffee can cause elevated blood pressure in those who aren't used to drinking caffeinated beverages. As is true of most things not used in moderation, it is pretty obvious that sucking down too much joe won’t do us a lot of good, but a couple of cups of fresh-brewed coffee won’t be likely to do most of us any damage, either.