A friend's daughter recently self-published a book about a close relative's battle with severe substance abuse. For a first time at bat, it's not bad. And the pretty-much-true story there is inspiring, for sure.
But reading through it from the perspective of one in long-term recovery (36 years C&S), I was as dismayed as I (along with my hero, Dr. M) usually am to note that the topic here was not examined. Or even recognized. Because it's a situation school-trained, addiction treatment professionals run into over and over and over again. And, moreover, a situation that so often leads a recovering substance abuser back into the clutches... sometimes once and for all.
Blessedly for me after slipping right into addiction switching after getting the plug in the jug and tossing out the connections' phone numbers back in 1984, my own AS did not (quite) kill me. But it almost did. Twice.
The protagonist in Ms. Yerxa's book turns to hyper-exercise in a manner not dissimilar to one of my own new obsessions in the mid-1980s: Long-distance bicycle racing. No more or less than sex, romance, social causes and work, I went fully (and diagnosably) obsessive-compulsive with that and other forms of physical exercise, and continued to do so until I began to break both mentally and physically from the buildup of lactic acid and its dangerous conversion to sodium lactate in the brain. (Other high-incidence addiction switches I run into here and elsewhere on a regular basis include food, gambling, online gaming and Internet pornography.)
In my case, the upshots included at least two forms of toxic-stress-induced bipolar spectrum disorders. My life from 1994 to 2003 was a never-ending cycle of "manic or panic" that took me to the psych lock-up eleven times, to the ER at least that many times... and cost me a career, a marriage and $440,000.00. Let me assure you: No One who has ever been through any of that wants to continue with being bipolar for another five minutes. Complex PTSD can be plain ghastly.
And yet, among recovering substance abusers who have not been through professionally administered treatment programs -- and even for some who have -- addiction switching runs rampant. Addiction and codependency treatment expert nonpareil Pia Mellody told us way back in 1991 that sex, romance and relationship were the truly fundamental addictions underlying almost all others. And that one had to clean house with respect to those to -- as another addiction expert named Anne Hardy told me even before that -- kill the core of addiction. (Hardy and her husband, Sam, ran a recovery home for adolescents in the Palm Springs area back then, and they had no doubt whatsoever about the cause of addiction among their teenage charges.)
(Mellody and the Hardys were already aware of Bozarth's, Carnes's, DiClemente's and Khantzian's ideas in those days. See the References below.)
I have attended Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Pills Anonymous and Marijuana Anonymous meetings since 1984. Until very recently, I've never heard anyone in any of those almost 10,000 meetings even say the words "addiction switching." (I am pretty much the only person who shares about that topic. But I do so regularly.)
Addiction switching is treatable and preventable. Chemical abstinence is mandatory at the outset. But then, it very often comes down to addressing the pressing question, "Will the Addict Ever Stop Using SOMETHING if He or She remains Depressed, Anxious & Belief-Bound?"
For me, at least, Ms. Yerxa's book was a very useful reminder of what can happen when that question remains unanswered.
So. Proceed at your own risk. "One can do anything they want in recovery so long as they're willing -- and able -- to deal with the consequences.
Published References and Resources
Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction Controversies, London: Harwood Academic Publishers, 1990.
Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.
Carnes, P.: Don’t Call it Love: Recovery from Sexual Addiction, New York: Bantam, 1991.
DiClemente, C.: Addiction & Change: How Addictions Develop and Addicted People Recover, New York: Guilford Press, 2006.
Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.
Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus (online), 2000.
Gorski, T.: Gorski-CENAPS Model of Substance Abuse Treatment, Springs Hill, FL: Gorski-CENAPS, 2001.
Hamilton, L.; Timmons, C.: Principles of Behavioral Pharmacology, Englewood Cliffs, NJ: Prentice-Hall, 1990.
Kannon, J.; et al: Narcotics Anonymous, North Hollywood, CA: Narcotics Anonymous World Service Office, 1981 through 2008 (one original and five revised editions).
Khantzian, E. J., Mack, J.F.; Schatzberg, A.F.: Heroin use as an attempt to cope: Clinical observations, in American Journal of Psychiatry, Vol. 131, 1974.
Khantzian, E. J.: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence, in American Journal of Psychiatry, Vol. 142, 1985.
Khantzian, E.J.: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.
Koob, G.; Le Moal, M.: Drug addiction, dysregulation of reward, and allostasis, in Neuropsychopharmacology, Vol. 24, 2001.
Koob, G.: Allostatic view of motivation: implications for psychopathology, in Motivational Factors in the Etiology of Drug Abuse, at the Nebraska Symposium on Motivation, Vol. 50, edited by Bevins, R.; Bardo, M.; Lincoln NE: University of Nebraska Press, 2004.
Koob, G., Le Moal, M.: Plasticity of reward neurocircuitry and the ‘dark side’ of drug addiction, in National Neuroscientist, Vol. 8, 2005, doi:10.1038/nn1105-1442.
Koob, G.: A Role for Brain Stress Systems in Addiction, in Neuron, Vol. 59, No. 1, July 2008.
Koob, G.: Neurobiology of Addiction, in Focus, Vol. 9, December 2011.
Mate, G.: In the Realm of Hungry Ghosts, Berkeley, CA: North Atlantic Books, 2010.
Mellody, P.: Miller, A. W.: Facing Love Addiction: Giving Yourself the Power to Change the Way You Live, San Francisco, Harper, 1992.
Prochaska, J.; Norcross, J.; DiClemente, C.: Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Live Positively Forward, New York: Harper-Collins, 1994.
Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.
Stahl, S.: Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 2nd Ed., New York: Cambridge U. Press, 2000.
Wilson, B.: Alcoholics Anonymous, New York: AA World Services, 1939, 1955, 1976, 2004 (one original and three revised editions).
Wilson, B.: Twelve Steps & Twelve Traditions, New York: AA World Services, 1951.
Wilson, B.: The Best of Bill: Reflections on Faith, Fear, Honesty, Humility and Love, New York: A. A. Grapevine, 1986.
No comments:
Post a Comment