Addiction Science

Shame About Alcohol Use May Increase The Likelihood Of Relapse

The study, conducted by researchers from the University of British Columbia, shows that behavioral displays of shame strongly predicted whether recovering alcoholics would relapse in the future.

Research on drug use goes down the toilet

Analysis Of Waste Water May Be The Key To
Determining Community Drug Use

Sewers don’t lie. People may be less than forthright about what they put into their bodies, especially if that includes illicit drugs, but a chemical analysis of what comes out of their bodies removes all mystery. According to drug and addiction researchers, analysing wastewater for remnants of illicit substances provides the only truly objective indicator of drug use patterns in a community.

“Whatever you think about drugs, people need to have objective data so they can at least have an informed discussion,” says Caleb Banta-Green, a research scientist at the University of Washington’s Alcohol and Drug Abuse Institute in Seattle.

Read More…

If I’m On A Suboxone Or Methadone Program, Am I Clean?

Q. Is being prescribed methadone or suboxone considered being clean, even though they are addictive, abusable substances?

You’ll get different answers to this question from different people.  Generally the division lies between those who are on maintenance drugs and those who are not.  Both sides of the discussion have their valid points.  However, I believe you answered your own question when you used the expression “addictive, abusable substances.”

The consensus among most professionals and recovering addicts is that “clean”, when used in the context of recovery, means drug-free.  Having all mood-altering substances out of our systems is necessary before the changes that addiction creates in our brains can be repaired.  As long as drugs that modify the reward system (which includes all recreational drugs) are in our bodies, repair and normalization cannot begin.  When we are on Suboxone or methadone maintenance, we are still addicted¹, and our brains are essentially in the same condition as when we were actively using other opioid drugs.  It would seem to be pushing things to call us clean.

That is not to say that there are no benefits to drug maintenance programs.  To the extent that they allow people to cease other drug use and begin to take care of themselves and fulfill their responsibilities, they have some validity.  The problem is that the addiction remains in full force, and relapse — whether to other drugs or simply recreational doses of the maintenance drugs — is only a hair’s breadth away.  Adherence to maintenance programs rests squarely on our willingness to continue to follow them.  That is an extremely dangerous place for an addict to be.

Here at Sunrise, we believe that the proper uses of these drugs are as short-term substitutes for the drugs being abused, with a relatively rapid taper to a completely drug-free condition.  If we wanted, we could easily become licensed to provide maintenance services.  However, we do not believe that is in the best interest of our patients, their families, and the other people in their lives.
¹If you don’t think we remain addicted on maintenance doses of opioid substitutes, just try quitting.  Both Suboxone (when used for long periods) and methadone have withdrawal syndromes that are worse than the drugs for which they’re being substituted.  Truth.

Why are the blood alcohol limits for drivers so low? I can function perfectly well after a few beers.

Q.  Why are the blood alcohol limits for drivers so low?  I can function perfectly well after a few beers.

A. Alcohol, aside from its addictive qualities, also has a psychological effect that modifies thinking and reasoning…. — The American Medical Association, in an official statement issued July 31st, 1964

We now know that having a drink of alcohol inhibits the executive functions of our brains.  The inhibiting mechanisms that control judgement, decision-making, and overall self-control are the first things affected by alcohol.  That’s why we experience that feeling of “freedom” when we’ve had that first drink: the feeling that we can relax, that we don’t have to hold the reins quite so tightly, that enables us to be a little more daring, take a few more risks, makes us more handsome, more beautiful and wittier (at least in our own mind), and that convinces us that we can drive just fine, thank you very much.

The abilities to drive skillfully, operate machinery, and carry out other dangerous activities that require judgement, decision-making and self-control are the very first things that we lose when we drink.  As you can see from the table below, other critical skills aren't far behind.  Combine that with the poor judgement that can make driving seem like a good idea, and we have a recipe for potential disaster.

Blood alcohol limits are set where they are because long experience and tens of thousands of blood tests on drivers involved in crashes and other driving escapades have shown that higher levels greatly increase the potential for trouble.  It’s that simple.  We may believe that we can drive better after a few drinks but, recall that good judgement is the first thing to go.  For a similar reason, the legal drinking age is held at 21, because younger drivers have not yet developed the judgement skills needed to drive with maximum safety, and certainly don’t need further impairment.  (The physical skills associated with driving have nothing at all to do with judgement and emotional stability.)

In the table below, “‘The second column lists behavioral areas by the first BAC at which 50% of the behavioral tests indicated impairment. That is, the point at which the majority of behavioral tests showed impairment. Note that, with the exceptions of simple reaction time and critical flicker fusion, all driving-related skills exhibited impairment by 0.070 g/dl in more than 50% of tests.” [The table was simplified for easier interpretation. The original can be found at the link shown.]



First BAC at Which 50% or More of Behavioral Tests 

Indicated Consistent Impairment

0.100 Simple Reaction Time, Critical Flicker Fusion
0.060-0.069 Cognitive Tasks, Psychomotor Skills, Choice Reaction Time
0.050-0.059 Tracking
0.040-0.049 Perception, Visual Functions
0.030-0.039 Vigilance
0.010-0.019 Drowsiness
0.001-0.009 Divided Attention

In the case of alcoholics and other addicts who use drugs that depress the central nervous system, the risks are multiplied exponentially.  We become impaired even beyond others who have had a few drinks.  The ability of most alcoholics to “maintain” and appear relatively sober to others and themselves is a specific, learned behavior that does not translate to driving and other skills.  We learn to function in spite of being impaired.

There are countries where you can be put in jail for having car keys in your pocket if you’ve been drinking.  Our more reasonable DUI laws can be clearly shown to be not only for you own good but for that of everyone on the road.

Why Do Addicts Keep Using Despite The Consequences? — Part 2

Previously we mentioned that the pleasure center is a portion of the brain over which we have no conscious control, and that it can be stimulated by a variety of chemicals — some of them produced inside our bodies and some that we introduce from outside.  We said that the pleasure center rewards us for activities that it interprets as contributing in some way to our survival, whether they be social interactions, exercising, or more prosaic things such as eating.  We also stated that these pleasurable feelings, when pursued too far or for too long can create problems.  Now we need to examine how that happens.

While the actual mechanism of addiction is terrifically complicated, the underlying principles are reasonably simple.

  1. When we use drugs or are involved in pleasurable activities, they stimulate (or cause the stimulation of) receptor sites in the pleasure center and other areas of the brain. This causes us to feel good.
  2. With constant stimulation, the brain begins to adjust to the higher levels of brain chemicals by making physical changes that involve, among others, the growth of additional receptor sites to accommodate the excess neurotransmitters.  This leads to tolerance: needing more stimulation in order to achieve the same effects.  Tolerance is one of the first signs of developing addiction.
  3. As tolerance develops, we reach a point where our brain needs the presence of the stimulation in order for us to feel normal.  If we cease whatever is causing the stimulation, whether it be alcohol, other drugs or stimulating activity, for very long we begin to feel uncomfortable because all those extra receptors are telling us they need to be filled up.
  4. Eventually, we reach a point where any pleasure is short-lived, and we simply need the stimulation to keep going.  When we don’t have it, we experience withdrawal, feelings that, as a general rule, are the opposite of whatever good feelings the stimulation caused.  If we were using cocaine or other central nervous system stimulants, we feel depressed; if using downers, agitated; if we are a thrill junkie, bored and/or depressed, etc.  Because of the changes in other parts of the body there are often other symptoms.  For example, opiate withdrawal is like the worst case of flu you can imagine, doubled, combined with overpowering anxiety, nervousness and generally feeling terrible both physically and emotionally.
  5. At the point of marked, prolonged withdrawal in the absence of the drug or activity, we are definitely addicted.

But why can’t we quit?  We know using is causing us life problems, and we know withdrawal doesn’t last forever.  There are even medications to help.  What’s with the constant failures to stop using?

Remember that we said the pleasure center is a part of the brain over which we have no conscious control.  This part of the brain, because it is survival-oriented, interprets failure to meet its needs as survival issues.  We have created an artificial situation in which the brain needs extra stimulation to feel normal.  Therefore, when it does not get the extra stimulation, it sends messages to our subconscious that our very survival is threatened.  Addicts continue to use because their subconscious, over which they have no control, tells them that if they don't they're liable to die.

Those messages alone are enough to make it extremely difficult to stop using.  When reinforced with physical withdrawal, they are sometimes impossible to overcome with conscious effort because — again — we have no control over the feelings or the symptoms except for the use of more drugs.

Of course there is more to it.  The stresses created in our lives by addiction-related problems (and perhaps problems that preceded the addiction) make it even more difficult for us to allow ourselves to return to reality.  We must first detox from the drug, and then we need a lot of support and help while normalizing our social, emotional and health issues during the first months and years of sobriety.  We also need help getting through the “post acute withdrawal syndrome” (PAWS) that occurs while the brain and rest of the body are rebuilding and getting back to something like normal.  This can take a long time, and the issues associated with PAWS are a frequent (if not the most frequent) cause of relapse.

That, however, is a subject for another article of its own.  For now, understanding that addicts are subject to powerful emotional and physical experiences over which there can be no direct control will clarify a lot about addiction and the problems of getting clean.

Why Do Addicts Keep Using Despite The Consequences? — Part 1

Early in human history there were probably few alcoholics or addicts, because the alcohol content available in fermented fruit was low, and plants that produced other intoxicating substances were relatively scarce.  The development of agriculture created food surpluses, especially of grain, the major ingredient in beer, and a class of workers that was not tied to food production.  These specialized occupations — brewing and raising non-food crops among them — allowed a gradual increase in the organized  production and consumption of mood-altering substances.

A field of opium poppies (DEA)

Brewing beer was widespread by around 6000 BC, and was extensively documented by the ancient Egyptians.  We know that alcoholism existed in biblical times, and that it was common by the time of the Greek and Roman empires.  It is likely that addiction to opiates and other drugs was present too, since images of opium poppies (Papavar somniferum) have been found in ancient Sumerian artifacts from around 4000 BC. The resin of these poppies was also known to the ancient Greeks, from whom it gained its modern name of opium. Humans being — well — human, it probably didn't take long for the abuse of these and other drugs to begin.  Drug abuse has been around for a long time.

For thousands of years, excessive consumption of intoxicants was thought to be a completely voluntary act, and people who used them habitually were believed to be morally weak or deficient.  Around the end of the 19th Century some physicians began to consider the possibility that, beyond a certain point, chronic use of alcohol and other drugs might become involuntary.  Further study confirmed these beliefs, and the American Medical Association declared alcoholism to be a chronic disease in the mid-1950s.  As time passed, the “disease model” of addiction has become more clearly developed, and now many experts view all addictions as chronic diseases with a strong organic component.

Still, why don't addicts stop using when it begins to destroy their lives?  To understand that, we need to look briefly at how the brain's pleasure center functions.

We like to feel good.  We enjoy music, the company of people with whom we feel a connection, good food, a drink or two, maybe a hit or a line.  We enjoy sex, which feels good and satisfies our instinctive desire to bond intimately with another human.  We like to win at sports and other games.  We get a thrill when we hunt.  Our survival instincts are deeply involved with the pleasure center, which gives us positive reinforcement for survival-oriented behavior such as making friendships (allies), winning at games (and war), and successful competition in the arena of business.

We enjoy these good feelings and emotions for themselves, but they also provide a welcome change from the unpleasant aspects of daily living.  Many other activities, such as shopping and gambling, provide pleasure, thrills, and distractions from our humdrum lives.  All of these activities are rewarded by the pleasure center, and eventually we may find that we seek them out too often, or for too long.

So, people use drugs and most other substances — including food — because they make them feel good or satisfy a powerful need (survival again).  Adding certain chemicals to our bloodstreams through natural bodily responses, ingestion and other means causes production of other chemicals that stimulate receptor sites in the brain’s pleasure center. Sometimes the substances themselves mimic the presence of “feel good” chemicals that occur naturally in the body.  Whatever the case, the results are various combinations of pleasure, satisfaction, and euphoria–sometimes all three.  It is important to note that these changes occur in parts of the brain over which we exercise no direct control.  When these good feelings begin to become the focus of our lives, rather than an occasional pleasure, we are well on the way to addiction.

But what is addiction, and why is it so powerful?  We’ll cover that in Part II.  Stay tuned.

Hepatitis Infection Soars in IV Drug Users Worldwide

In a study published July 28th, 2011 in The Lancet,  Paul Nelson, from the National Drug and Alcohol Research Center at the University of New South Wales in Sydney, and colleagues, reported their analysis of  data from multiple international reporting sources. They found that rates of hepatitis C infection among injection drug users (IDUs) were 60 to 80 percent in 25 countries and greater than 80 percent in 12 other countries. Hepatitis can lead to cirrhosis, liver cancer and liver failure. It is the number one reason for liver transplants in the US.

CDC Image

The results show that the top countries for infection were: The United Kingdom (50 percent), New Zealand (52 percent), Australia (55 percent), Spain (80 percent), Norway (76 percent), Germany (75 percent), France (74 percent), United States (73 percent), China (67 percent), Canada (64 percent), Italy (81 percent), Portugal (83 percent), Pakistan (84 percent), the Netherlands (86 percent), Thailand (90 percent) and Mexico (97 percent).

According to the researchers:

“The public-health response to blood-borne virus transmission in IDUs has mainly centered on HIV. Maintenance and strengthening of the response to HIV in IDUs remains crucial, but the significance of viral hepatitis needs to receive greater attention than it does at present,”

“Efforts to prevent, treat, and reduce harms related to liver disease in IDUs are essential — especially in situations in which HIV has successfully been prevented or managed — because the large numbers of IDUs infected with HCV and significant morbidity resulting from this infection mean that the health and economic costs of HCV transmitted by injected drug use might be as high as (or higher than) those of HIV.”

“Nonetheless, HCV treatment is underused. Part of the reason for this neglect is the high cost, which will remain a substantial barrier to increasing of treatment coverage in low-resource settings until costs are reduced”

Of course, enlightened clean-needle programs and similar measures could substantially reduce the incidence and cost of infections, but only a few countries — conspicuously not including the United States — have seen fit to implement such measures.