Tuesday, May 13, 2014
Tuesday, March 5, 2013
#16 Children of Addiction
One in four children lived with an alcoholic or other
drug addict while growing up. When we include other addictions (gambling,
eating disorders, pornography etc.) who knows how to measure the impact on
children in our current addictive culture. Most have experienced some form of
neglect or abuse.
A relationship between parental addiction and child abuse
has been documented in a large proportion of child abuse and neglect cases. A
national study of welfare professionals showed that 79.6% cited substance abuse
contributing to at least 1/2 of all cases of child mistreatment they see.
Another 39.7 of workers said it is a factor in 3/4 of their cases. It is
estimated that 80% of welfare spending is due to substance abuse and addiction.
A child raised in such an environment may have a variety
of emotional problems. They may struggle with guilt as small children often see
themselves as the main cause of family problems. They may worry constantly
about the situation at home and may fear fights and domestic abuse between the
parents, or the high possibility of divorce. The addiction is kept a secret and
children may feel ashamed to invite others home. They are ashamed and afraid to
ask anyone for help.
Because the child has been disappointed by the addicted
parent(s) so often they often struggle to trust others. They are generally
confused by the lack of a regular schedule and the mood swings of the parents.
Often the children are very depressed feeling lonely and helpless to change the
situation.
Although trying to keep the addiction as secret, children
often exhibit acting out behaviors. They may fail in school and be truant. They
may start stealing or exhibit violence. They frequently have physical complaints such
as headaches or stomachaches. They are at high risk for becoming addicted
themselves, and their age of initial substance abuse the earliest.
Some children of addicts take on acting like responsible
parents. They can become overachievers yet still be emotionally isolated from
others. To keep the family system together they assume roles that should be
taken by the addicted parent(s).
Again, children of addiction are high risk to become
addicts themselves or highly co-dependent and get involved in tangled
relationships with addicts.
Monday, February 25, 2013
#15 Genetics
Genes are part of our DNA and are needed to give
instructions for how to make and operate all parts and functions of our bodies.
It is estimated there are over 40,000 different genes, and about one half of
these affect the human brain. The knowledge that living things inherit traits
has been used all through history to improve crops and domestic animals through selective breeding.
With the advent of genetic testing, this science exploded
in the early 70's and researchers began to profess that genes determined our
destiny. This began to raise many ethical questions. For example there were
fears were that if someone's genetic code revealed a predisposition to a
disease, an insurance company with this information would refuse medical coverage.
The conventional view was that since DNA carries all our inheritable information, nothing an individual could do in their lifetime could change what was inherited.
Family, twin and adoption studies have shown that
alcoholism does have a genetic component. Scientist's initially looked for a
particular gene to explain addiction, but now we know that multi-genes are
involved.
Although genetics plays a large role in the appearance
and behavior of all living things, it is the combination of genetics with the
life experiences of an organism that determines the ultimate outcome. For
example, while genes play a role in determining an organism's physical size, the nutrition and overall health it
experiences after inception also has a large effect.
This means that every
person's life experiences re-design and affect the genes we inherited. We know
now the reality of our inherited genetic makeup is not deterministic, but more
likely demonstrates predisposition. About one half of addiction has some roots in a genetic
predisposition. This doesn't mean that addiction is already determined for someone
who inherited these genes and one is destined to be an addict. But they are
more at risk. It does mean someone with the probability of inheriting these genes
must use caution and be vigilant as they evaluate their use of mind altering
chemicals.
One of the most exciting recent developments in
understanding our brain and its relationship to behavior is something known as
epigenetics. It is the study of changes in gene activity that do not involve
alterations to the genetic code, and still get passed down to at least one
successive generation. But they tell your genes to switch on or off, to speak
loudly or whisper although thery do not alter them in any way.The
effects can be good or bad depending on many factors:
POSITIVELY: diet and nutrition
(essential minerals and vitamins),
meditation, exercise (running particularly) and
enhancing our
sense of belonging and identity in cultural - social - spiritual
spaces
(Posts #4, #5, #6).
NEGATIVELY: smoking and other addictions,
trauma,
starvation, toxic chemical exposure, and dislocation (Post #7).
starvation, toxic chemical exposure, and dislocation (Post #7).
This
means that the impact of our genetic predispositions can be modified or even shut down with
healthy and balanced lifestyles.
This
has all kinds of implications in recovery and helping prevent relapse. For
example it has recently been shown that those that quit smoking at the same
time they quit their drug of choice have a better chance of getting and staying
clean and sober. Historically it was maintained that quitting one addiction at
a time was stressful enough. In early recovery most recovering addicts report
doubling the amount they smoked while using.
On a
positive note, seeking a balanced and healthy lifestyle in addition to
abstinence enhances a life of sobriety and the pursuit of emotional sobriety for
those in recovery.
In my
next post we will discuss children with addicted parents.
Tuesday, February 19, 2013
#14 Harm Reduction
It is necessary to have read last week's Post #13 Stages of Addiction and Homelessness to put my views about Harm Reduction in context. I think it is a valuable
strategy to help those in 4th stage addiction. They are without homes, living lives of
oblivion and not really caring if they live or die. They don't seem to have the moments of clarity we commonly call a bottom. I was initially resistant to Harm Reduction until being exposed to the levels of addiction in Vancouver's DTES and the inability to help with traditional methods.
Harm Reduction aims to meet substance abusers “where they are
at” as opposed to immediately imposing abstinence. It helps prevent unnecessary
hospitalizations due to preventable infections and diseases. It is trying to
keep people alive and healthy while working to engage them in treatment for
their addiction. It is doing things for the addict they are unable to do for themselves which is different than enabling. Criticism of harm reduction typically centers
on concerns that tolerating risky or illegal behavior sends a message to the
community that these behaviors are acceptable. Again, I am recommending Harm Reduction strategies only for 4th stage addiction.
To be effective Harm Reduction needs to
be part of a "Four Pillars" approach which includes Prevention, Treatment, and Enforcement (Protection over Prosecution). Decriminalization
for using drugs and limiting prosecution to drug related crimes (including manufacturing and sales) would drastically lower prison populations where sadly
there are few treatment programs. There are many who abuse drugs but do not break other laws. The National Institute of Health estimates that only 9% of alcoholics end up in prison or homeless.
The Housing First
model is simple: provide housing first, and then combine housing with
supportive services in the areas of mental and physical health,
substance abuse treatment, education, and employment. Housing is provided in apartments
scattered throughout a community. This "scattered site" model fosters
a sense of home and self-determination, and it helps speed the reintegration of
clients into the community.
Providing housing and
support services for homeless addicts costs less than leaving them on the
street, where taxpayer money goes towards police, shelter and emergency health
care. Residents are required to pay about 30% of their income including welfare
towards rental. Housing First
restores dignity and offers space and encouragement for change to take place. Imagine the addict thinking, "why should I go through treatment when I have no place to live but the street and its drug culture when I leave!"
Research in major cities shows lifting the ban on alcohol use in homeless projects lowered consumption
40%. The Pennsylvania Hotel experiment in Vancouver provides 8 ounces of alcohol per day
which keeps residents from going into the Delirium Tremens of withdrawal and
the associated risks of drinking Illicit alcohol (any alcohol not bought in a
liquor store like rubbing alcohol, mouthwash, hand cleaner etc). Last year
their research showed a 62% decrease in the consumption of alcohol.
What is encouraging, is
that many 4th stage addicts who participate in these Harm Reduction programs go into remission to 3rd stage
addiction where moments of clarity are possible and opens the
possibility of recovery. With the Housing
First initiatives, they become part of a social - cultural community necessary for recovery (blogs #5
and #6: Proxemics).
Probably the most
controversial Harm Reduction approach
in Vancouver's DTES is InSite, the only legal supervised injection site in
North America. It provides a safe and health-focused location for drug
injection. The clinic does not supply any drugs but registered nurses supervise
the injection and are prepared to handle any emergencies. In1996 there were
2,100 cases of HIV reported in the DTES. After the formation of InSite, in 2006 there were only 30 new cases
of HIV. There have been 2,492 clinical medical treatment
interventions, and 6,242 referrals to other social and health facilities (mostly
for detox and addiction treatment). Of the referrals, 40% began treatment and it
has been shown that InSite users are 2X as likely to engage in treatment than
non-Insite IV users.
In 2009 484 overdoses
occurred with no fatalities, due to intervention by the medical staff. There is also
a government sponsored Detox center called OnSite upstairs. Of 411 admissions last year, 55%
completed detoxification which is a remarkable statistic.
Much resistance to InSite has come from the evangelical church. This was addressed in a lecture last year by Dr John Stackhouse and Nurse Meera Bai from Regent College Seminary in Vancouver. I think understanding addiction in 4 stages and restricting Harm Reduction to the 4th stage would lower resistance from the evangelical community.
Methadone clinics were started in the 60's primarily to address the crime rate associated with the heroin epidemic. It did reduce the crime rate however the federal government did not follow up with recovery programs that were supposed be included. Without integration with other harm reduction programs I feel methadone clinics mostly fail 4th stage addicts. Methadone is harder to withdraw from than heroin. Many 4th stage addicts take their oral methadone daily at clinics or pharmacies to prevent opiate withdrawal, but then pursue other drugs including alcohol through the day.
Methadone is currently being prescribed as a common pain killer for its benefits as a pain killer and its low cost. For many, this adds to the current opiate addiction epidemic when not regulated closely. In its pill form it can be powdered and injected making it valuable on the street. The cost of today's China White heroin (very pure) today is cheaper on the streets than scripts of methadone and heroin becomes attractive with prescription addicts.
What has been helpful and encouraging is the advent of Suboxone in pill form for opiate addiction. It stops the horrible withdrawal as an agonist and if opiates are taken they have no effect as Suboxone blocks the receptors as an antagonist. It requires monthly involvement with a specially licensed physician, and the good ones insist the person be involved in some type of recovery. The treatment ideally is limited from 3-6 months as the Suboxone dosage is gradually titrated.
My next blog will explore the role of genetics in addiction.
Methadone clinics were started in the 60's primarily to address the crime rate associated with the heroin epidemic. It did reduce the crime rate however the federal government did not follow up with recovery programs that were supposed be included. Without integration with other harm reduction programs I feel methadone clinics mostly fail 4th stage addicts. Methadone is harder to withdraw from than heroin. Many 4th stage addicts take their oral methadone daily at clinics or pharmacies to prevent opiate withdrawal, but then pursue other drugs including alcohol through the day.
Methadone is currently being prescribed as a common pain killer for its benefits as a pain killer and its low cost. For many, this adds to the current opiate addiction epidemic when not regulated closely. In its pill form it can be powdered and injected making it valuable on the street. The cost of today's China White heroin (very pure) today is cheaper on the streets than scripts of methadone and heroin becomes attractive with prescription addicts.
What has been helpful and encouraging is the advent of Suboxone in pill form for opiate addiction. It stops the horrible withdrawal as an agonist and if opiates are taken they have no effect as Suboxone blocks the receptors as an antagonist. It requires monthly involvement with a specially licensed physician, and the good ones insist the person be involved in some type of recovery. The treatment ideally is limited from 3-6 months as the Suboxone dosage is gradually titrated.
My next blog will explore the role of genetics in addiction.
Monday, February 11, 2013
#13 Stages of Addiction and Homelessness
It is important to put my following comments in context. The number one cause of homelessness today is poverty, and more social services aren't needed, it's about needing jobs! Vancouver's 12 block DTES area is an exception -- most are addicted or have mental health issues. It has the highest concentration of IV users in North America.
My compassion for the homeless in Vancouver's DTES was initially stirred reading In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Mate. My previous experience with the homeless was limited to occasional visits to shelters. I did know some folks in AA who had been homeless for brief times and now had functional lives, but few long timers at the missions really showed any interest in AA or what churches had to offer.
As a counselor I was effective with those who had been abused as I had been helped so much in my own treatment and therapy. I knew many of the long term homeless were horribly psycho-socially-spiritually damaged. They rarely recovered and I didn't understand why. Traditional thinking was they haven't reached a bottom but when someone has almost died a number of times, lost everything, and only staying alive due to shelters, I was puzzled what would a bottom look like?
The following
diagram by Ric Matthews (Executive Minister of New Way Community) helped to clarify my understanding of homelessness.
The first circle outside MAINSTREAM are the MARGINALIZED,
or those not fitting in due to addiction and mental health issues. Even though poverty is
the number one cause of homelessness but I often question which came first...poverty or addiction? Society attempts to repair or contain these folks in institutions (recovery groups, church, treatment, hospitals
and prisons). Those we can't seem to help, slip out to the next circle or the
HOMELESS. One of the errors we make is expecting them to be rational but
addiction and mental illness are not rational conditions. The most damaged often
don't fit the barriers of many shelters and become PREMATURE DEATHS from drug
overdosing, related medical conditions and inclement weather.
Generally addiction in seen in four stages: Experimentation, Misuse,
Abuse, and Dependency. My problem is by these criteria, my diagnosis when
practicing my addiction was the same as the homeless in DTES. For a number of
reasons, I wasn't as damaged and had so many more opportunities in life
compared to so many who are homeless. With help I was able to recover and be
restored to the MAINSTREAM at the center of the diagram without slipping into
homelessness.
So many I meet and spend time with in Vancouver's DTES have not
responded to traditional treatment and other assistance. I think first of all
we need to rethink how we discuss and understand stages of addiction.
It is multi causal but addiction can be seen as a brain disease. Other
diseases are seen in four stages. The fourth stage is so critical in cancer that patients
are told it has metastasized to other regions of the body and is rarely
considered curable. Patients with fourth stage heart disease, cirrhosis, and
kidney disease must have transplants to live.
To understand the marginalized homeless I am proposing
understanding addiction in four stages.
Stage 1: Initial
Motivation is pleasure...
“They
Abuse and Live”
Stage 2: Chronic
Motivation is relief...
"They Live to Abuse”
Stage 3: Acute
Motivation is maintenance...
“They Abuse to Live”
Stage 4: Terminal
Motivation is escape to
oblivion...
“They Abuse and Die”
Stage 4 addicts do not seem to have moments of clarity or
respond to a bottom. They are not currently criminal enough to end up in prison
or considered mentally ill enough to end up in psychiatric care. So what would
be involved for them to recover?
My next post will focus on the Harm Reduction controversy
and its impact in the context of Stage 4 addiction.
Tuesday, February 5, 2013
#12 Willpower
The role of willpower is probably the most controversial issue in discussions of addiction, its roots, and recovery. Initially some views seem contradictory. On one hand are those that see addiction as merely another disease and feel the individual is no more responsible than having any other disease. On the other hand are those who talk about free will and choice, and that addiction is simply a choice.The discussion often polarizes into "either or" options. I would like to suggest that another option might follow a "both and" discussion as there are contradictions in both schools of thought.
· Impulsive: This
exercise of will generally originates in the instinctive part of the primitive
brain and moves towards things that are attractive or trigger curiosity. It
generates exploration but requires little forethought (which originates in the
neo-cortex). For example we safe guard electric sockets knowing that small
children impulsively stick a fork or their fingers in them. In adults it is
simply choosing what is desired without using reason (eg. impulse buying).
· Reflective:
Experiencing either negative or positive experience from an impulsive act, we
reflect on the consequences or rewards of an impulsive act and evaluate if the
activity is in our best interests before acting on it.
· Embodied: Desires
have enslaved the will and
bypass reflection or moments of clarity as now
their body is running their life in terms of desire
and the pursuit of pleasure.
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