It is well known that relapse is common for those in early recovery from addiction. Also well known is that those with a history of child abuse are more likely to abuse substances in adulthood. A recent study now links the two – showing that those with history of substance abuse who are in early recovery have a higher propensity for relapse.
New York University School of Medicine and Yale University School of Medicine researchers published their recent findings in the American Medical Association journal, JAMA Psychiatry, showing the link between the two and highlighting the potential difficulty of treating adult addicts with a history of abuse. The researchers used MRI scans to look at the brains of 79 people in substance abuse treatment, some with a history of child abuse and others without. The researchers looked for changes in the brain previously associated with an increased risk for substance abuse relapse. They found these changes to be more prevalent among those who had a history of child abuse. The research showed that the increased risk of relapse pertained to all addictive substances. The study also noted that as many as 5 out of 10 people who experience neglect or childhood abuse will develop substance abuse problems and will have a high rate of relapse.
The findings also discussed the challenge of having effective treatment for those with child abuse in their history because the relapse potential is so high. However, addiction treatment centers like Harmony Foundation already consider abuse history when crafting treatment plans for new clients and programs for those who had relapsed. Because the rate of relapse is high for those in early recovery in general let alone those with a history of abuse, offering relapse prevention groups and therapeutic opportunities to recognize and face triggers is essential in addiction treatment.
An important question to consider in addiction treatment programs is how safe are supplements? While multivitamins are generally safe, the rise of supplements to enhance physical and mental performance may be risky for the general population and especially those in addiction recovery. A recent class of supplements known as nootropics have been marketed online, especially through social media sources like Facebook. They promise to help with concentration, attention span and overall cognitive function – boosting memory, alertness and mental performance.
The target audience for these supplements are young college age adults and young working professionals and the demand is growing. Take, “Alleradd” for example, a play on the word for the drug “Adderall” that uses this marketing statement: “Alleradd elevates your energy, enhances your memory, and helps you find your focus, even if you are tired or stressed out.” AlternaScript says that among those who use their product are students, entrepreneurs, athletes and business executives. They also say they can deliver these benefits without the side effects of prescription drugs. Such marketing tactics make the unsuspecting believe they must be safe and even beneficial for use.
Unfortunately, these supplements may provide a “gray area” for addicts in recovery who don’t consider supplements mood altering and aren’t considered controlled substances. However, if drugs like Alleradd deliver similar effects to drugs like Adderall, then these pose a risky slippery slope for addicts. They certainly qualify as mood or mind altering, according to their marketing slogans, and may give an addict a “taste” of a high that could lead to a full-blown relapse. The commonly used phrase in Narcotics Anonymous that “one is too many and a thousand is never enough” is highly applicable to these supplements. They likely provide the former stimulant abuser, for example, with a feeling of the high, but not quite enough – which may influence them to seek the real thing.
While addiction treatment programs should educate clients on these supplements, the general population should be cautioned as well. Just like with synthetic drugs, little is known about the physical and mental effects of the combination of supplements like piracetam and tyrosine in nootropics even if they are “natural.” Unfortunately it usually takes a few adverse events for the FDA or other government agencies to ban such products. Until then, education and caution should be used – especially for addicts in recovery who may be vulnerable to the marketing tactics of AlternaScript, the makers of Alleradd.
A few weeks ago we wrote about Philip Seymour Hoffman’s death and the media frenzy spawned ill informed comments about addiction and his death. Last week an article published in the New York Times entitled “Truth and Prize Emerge From Lies About Hoffman” interviewed Hoffman’s friend, David Bar Katz, who shed a more realistic light on Hoffman’s addiction and the disease in general.
Mr. Katz relayed some details about the night of Hoffman’s death, saying he had invited him over to watch the Knicks game, “The fact that he wanted me to come over for the Knick game meant that he did not want to be doing the drugs, because he never did them in my presence,” he said. Katz is right – one of the most common traits of addicts in active addiction is isolation. At our addiction rehab, clients share their anecdotes about being alone and isolated at the end, doing their drugs alone and often not socializing because they wouldn’t be able to use substances how they wanted to. This is the case for most addicts – from food addicts who binge alone late at night to alcoholics who prefer their poison at home rather than with others at a bar. For many coming out of this isolation into rehab centers, it takes a while to get their social and communication skills back.
Shedding more light on the reality of Hoffman’s addiction, Mr. Katz also relayed, “Hoffman once said to me, ‘Addiction is when you do the thing you really, really most don’t want to be doing.’ He was rigorously sober and had an awful relapse.” Hoffman’s explanation of addiction here is one of the best portrayals of what addiction is like, and a good way to depict addiction to the non-addict.
Addicts do what they hate the most in active addiction but are often unable to stop. Non-addicts may not understand exactly why they are unable to stop but it still gives them a realistic glimpse into the painful life of an addict. In fact, aside from understanding the disease model of addiction addicts sometimes don’t even know themselves why they got started or why they were unable to stop. In addiction treatment, we try not to exert all our energy on the why – and we encourage clients that they don’t have to understand or know or understand everything in order to recover. If the focus is placed on the present, the recovery process and the therapeutic tools at their disposal, many have a good chance of long-term sobriety. Soon enough the isolation, the self defeating behavior and trying to understand the why subsides.
For many recovering addicts, the tragedy of Philip Seymour Hoffman was a humbling reminder that no matter how many years someone has sober, the disease is still there – doing proverbial “pushups” and that relapse is never off the table.
The disease of addiction progresses even when addicts are not using, which is hard for addicts and others to wrap their minds around until they hear real life tales of how this happens. Hoffman’s story is a very real life example of this: police reported to several news agencies they found 5 empty bags and 65 additional bags full of heroin in his apartment the night he died. He got sober in his early 20s, remained sober for 23 years and just a few years later overdosed with heroin in extreme excess. This is a classic case of the disease doing push ups and progressing even after laying dormant for over 20 years.
Sentiments of sadness spread through sober communities across the US after his death along with those of frustration over the varying public opinions on what addiction is, many of which were expressed in a way that suggested addicts purposefully choose their demise. It makes those in recovery want to tell the world how it really is – but then they harness the principals of the program and let the opinions of others live and let live.
Aaron Sorkin who is in recovery from addiction wrote a poetic piece yesterday for Time that shed some light on addiction and relapse in response to varying opinions. He said Hoffman wasn’t acting on choice; “He didn’t die because he was partying too hard or because he was depressed — he died because he was an addict on a day of the week with a y in it” – suggesting that when the disease of addiction is active, it doesn’t matter what day of the week it is or what sentiments surround substance abuse, it just takes over everything, including lives, because it is real.
Because we understand the disease of addiction, its progression and the reality of relapse, Harmony Foundation specializes in relapse prevention and treatment. We help addicts identify the triggers that can lead to a relapse and welcome those who have relapsed back into our care. We try to intervene before tragedy strikes and lay our hearts heavy when it does. Our hearts, thoughts and prayers go out to Philip Seymour Hoffman and his friends and family and all others who have lost their lives to this terrible disease.
Today is Super Bowl Sunday when many parties abound that lead to overindulgence in eating, drinking and other self-defeating behaviors.
Many who are newly sober find this day difficult because beer and watching football are portrayed by the media to go perfectly hand in hand. In fact, beer manufacturers like Budweiser spend millions on their commercials leading up to and on Super Bowl Sunday.
Given that the game is in New York City this weekend, scandals and stories related to Super Bowl weekend partying were inevitable. On Thursday New York City police arrested 18 people for selling “party packs” and high end prostitutes to wealthy clients in town for the festivities.
The arrests came after a nearly year long investigation organized by DHS, NYPD and a state-wide Organized Crime Task Force coordinated by New York Attorney General Eric Schneiderman’s office. The raids began on Wednesday night at the Brooklyn Marriott hotel where participants in an Internet prostitution ring were arrested. Some of the prostitutes who were solicited for $1000 an hour were brought all the way from Florida and Virginia.
On Thursday another ring was arrested who targeted wealthy clients in town for the Super Bowl. The arrested prostitutes had planned on delivering cocaine to clients who ordered “party packs.” To promote their services, the drug and prostitution ring send a text to customers 10 days ago saying “new sexy & beautiful girls R in town waiting for u.” And in the past, after getting clients high on drugs the ring would flood the room with additional prostitutes and repeatedly charge their credit cards, up to more than $10,000 for a night.
While the arrests were a success and may have cut down on some partying ahead of today’s events, Attorney Schneiderman said, “drug trafficking and prostitution are a scourge on communities across our state,” so the arrests may have just made a small dent.
While some people can use drugs or indulge in illicit behavior during what are ordained as “party weekends” like this weekend, many cannot. Many find themselves engaging in the behavior more often than they had planned and eventually need substance abuse treatment. That is because the deeper issues that lead them to be ok with indulging in the first place need some attention.
Relapse prevention is an essential component of recovery and there are endless tools that help addicts avoid a relapse. One such tool is picking up the phone, often referred to as the “50 pound phone” because it is hard to make a phone call when we are feeling our worst.
Even those who are in their double digits – 10 years or more – of sobriety occasionally struggle, as expressed recently by Russell Brand in a blog post he wrote about relapse. “The last time I thought about taking heroin was yesterday,” he wrote on his website, russellbrand.tv. But, recognizing his thought was fleeting and that the promises of recovery outweigh the ill fated reality of active abuse of drugs and alcohol, Brand says he picked up the phone: “Even as I spin this beautifully dreaded web I am reaching for my phone. I call someone not a doctor or a sage not a mystic or a physician, just a bloke like me, another alcoholic, who I know knows how I feel.”
Just picking up the phone and calling someone to talk about triggers (in Brand’s case it was bad news from a woman) can help immeasurably because fellows in recovery have been through similar situations and sentiments. That is why in 12 step meetings people often say, “I have a sponsor and my sponsor has a sponsor” because somewhere, someone has had the same experience and can share how they got through it – sans alcohol or drugs.
Often in active addiction people struggle with what is coined “terminal uniqueness,” thinking that no one has walked in their shoes and experienced what they have. When they get sober and share what they thought of as unique experiences, they realize they are far from being alone, and that their sponsor – or their sponsor’s sponsor – has experienced the same thing and can shed light on how they overcame it.
Making a phone call a fellow in recovery is one of the most powerful tools to avoid relapse because, as Brand says, “the price of this [recovery from addiction] is constant vigilance because the disease of addiction is not rational.” Therefore, staying in one’s own head, filled with triggers and temptations may not serve up a rational answer – but someone on the other end of the phone line can provide some rationality to help us stay sober.
Would a test that can predict alcoholism and relapse tendencies prevent youngsters from trying out drinking? There have been numerous studies conducted on the genetic predisposition toward alcoholism – most of which say that if one of your parents is an alcoholic, you may become one, if both parents and most of your lineage are alcoholics, you will probably become one. Despite this knowledge, people at risk still chose to try out drinking – walk into any 12 step meeting and you will hear variations on the same theme, “both of my parents were alcoholics” which suggests learned behavior and nurture vs. nature, but another common story is “both of my parents met in AA and were sober my whole life” which speaks to the natural genetic predispositon vs. nurture.
Despite the self-knowledge of a potential genetic predisposition, many still test the waters, but some think this may change if a test showed those at risk hard evidence. An article published this week in Nature Neuroscience showed that a behavioral test may be able to do just that – give hard evidence on who may have trouble with alcoholism and chronic relapse. Jane Taylor, a professor at Yale School of Medicine says, “What is encouraging about this study is that we have identified both a behavioral indicator and a molecule that explains that risk.” The behavioral indicator showed that the same mice who reacted to a certain food cue also exhibited alcoholic tendencies. The Yale researchers also found that the mice that showed alcoholic tendencies had greater brain plasticity as measured by levels of the molecule PSA-NCAM. Mice with low levels of this molecule had less of an ability to control their alcohol seeking behavior whereas those with greater PSA-NCAM were more flexible in their behaviors around rewards. “This would make sense since alcoholism is associated with a lack of neurobiological and behavioral plasticity,” Taylor says. “The brains of alcoholics seem to get stuck in the same patterns of activity.” If the testing of PSA-NCAM becomes available to the public, it would be interesting to see if it would serve as real prevention tool for those who know they have less ability to control their alcohol consumption and more of a likelihood of relapsing even if they did stop. So far, the self-knowledge that one may have a genetic pre-disposition prevents some from testing the assumption, but not all. If you or a loved one suffers from alcoholism or relapse, our Colorado alcohol treatment program and relapse program can help.
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