Answer Addiction

Tag: Kristance Harlow

  • Long Term Effects of Overdoses on the Brain

    Long Term Effects of Overdoses on the Brain

    Despite what we know about how overdoses can kill, there is scant literature regarding chronic health outcomes for people who have survived multiple overdoses.

    Drug overdoses are a leading cause of preventable deaths in the United States. We know the dangers of overdoses; generally, they can kill. Opioids make up a large percentage of these deaths. In 2016, opioids made up 69 percent of drug overdose deaths. For people ages 25 to 64, drug overdoses cause more deaths than car accidents. Overdoses caused by opioids can be reversed if quickly countered with naloxone, an opioid antagonist.

    In states like Massachusetts, opioid overdose deaths are on the decrease, but overdose emergency calls are on the rise. More people are surviving, but only 3 out of 10 people are receiving medical treatment for substance use disorder. What is happening to the other 70 percent of individuals?

    Non-Opioid Overdoses

    It is technically possible to overdose on nearly any recreational or medicinal drug available.

    Cocaine overdose can involve seizures, heart attacks, strokes, and/or stop a person’s breathing. Amphetamine overdose can lead to seizures, cardiac arrest, and/or a huge spike in body temperature. Psychologically, high doses of stimulants can cause severe psychosis. MDMA overdoses have some similarities to stimulant overdoses, including increased body temperature, kidney failure, and hypertension. Alcohol overdoses most often occur when a person engages in binge drinking which can lead to breathing problems and interfere with cardiac functioning. 

    The Mechanics of an Overdose

    Heart problems and oxygen deprivation are two common symptoms of an overdose that we see in many drug-related deaths. But what happens to the brain during an overdose? Are there lasting effects? Can an overdose cause permanent brain damage?

    The body is being poisoned during an overdose, and it’s usually not obvious to the person who ingested the substance. Someone who has just taken a lethal amount of opioids is unlikely to recognize what’s happening, although others may. As described by Maggie Ethridge for Vice, signs include “extreme drowsiness, cold hands, cloudy thinking, nausea and/or vomiting, and especially slowed breathing (fewer than ten breaths per minute).”

    Once ingested or injected, an opioid makes a beeline through your heart and into your lungs. While in the lungs, your blood gets a dose of oxygen and that “now opioid-rich blood is pushed out to the rest of the body, where it plugs into the system of opioid receptors all over your body.” As the opioids enter the brain, they cause the neurotransmitter dopamine (the feel-good chemical) to overflow. That’s where the feeling of euphoria comes from. After repeated use, reaching that blissful state becomes harder, requiring increasingly larger doses of the same drug.

    If you’ve overdosed, the next thing that will happen is that your brain’s basic systems that control breathing will be affected and your breathing will slow before stopping entirely. Circulatory functioning is next to be affected; your heart rate will slow as the opioid dampens neurological signaling in the brain. As your oxygen levels reduce, your heart begins having irregular rhythms and this can lead to a cardiac arrest.

    Opioids are a depressant, decreasing heart rate and breathing. Overdosing on opioids essentially causes the central nervous system to go into such a depressed state that the body forgets to breathe. Without enough oxygen (hypoxia), the brain can become severely damaged. The longer someone goes without oxygen, the worse the damage can be.

    Certain parts of the brain are more sensitive to the immediate effects of oxygen deprivation. The frontal lobe is particularly at risk of damage when experiencing anoxia (zero oxygen reaching the brain), resulting in problems with executive functioning. Executive functioning refers to a set of mental skills in the areas of working memory, inhibitory control, and cognitive flexibility. If a person experiencing an overdose has a seizure, this can cause further damage to the brain.

    Toxic Brain Injury

    Substance use disorders and brain injuries go hand in hand. An estimated 25 percent of people who enter brain injury rehabilitation have had problems with drug use and half of people entering substance use treatment have experienced a brain injury. Each of these conditions makes the other worse. 

    Toxic brain injury is a term that has been coined to encapsulate the type of injuries that occur after an opioid overdose. It is also referenced under the category of acquired brain injuries, which include instances of brain damage that occur after someone is born but are not connected to degenerative or congenital diseases. 

    The white matter of the brain can sustain damage from repeated oxygen deprivation. The consequences of toxic brain injury increase if someone experiences multiple non-fatal opioid overdoses. Despite what we know about how overdoses can kill, there is scant literature regarding chronic health outcomes for people who have survived multiple overdoses. What research does exist focuses on brain injuries due to hypoxia/anoxia.

    From what we do know, certain areas of the brain are most likely to be harmed and can “lead to the development of severe disability.” These areas affect neurological processes; short-term memory loss, disorientation, even acute amnesia have been observed. Survivors may develop physical problems such as loss of control over bodily functions, lack of coordination, nerve damage and subsequent reduction in the ability to use a certain limb or body part, or even paralysis. Less severe but still serious symptoms include slower reaction times, motor skill disturbances, memory problems, and overall “diminished physical functioning.”

    Medical Treatment

    Only 3 out of 10 people who overdose on opioids and survive seek medical treatment for addiction. For every reported overdose death, there “may be five nonfatal overdoses, many of which go unreported.”

    This isn’t to say that anyone who has ever survived an overdose has brain damage, but rather that more research and advocacy needs to focus on surviving overdoses and how to best move forward with healing and increasing rates of recovery.

    NASHIA (National Association of State Head Injury Association) recommends that substance use disorder treatment services should be available and accessible for people who have sustained a brain injury. They also recommend that medical providers regularly screen patients for a history of brain injury and to ensure that people can receive treatment for any cognitive, behavioral, and/or physical disabilities due to a brain injury.

    Reducing overdoses is a critical aspect of preventing these kinds of chronic injuries. Once a person has one overdose, they’re more likely to have another, and that likelihood increases with each overdose. When available and implemented, harm reduction principles work to reduce this likelihood and improve outcomes. There is no one-size-fits-all approach to recovery from substance use disorder that will work for everyone. Harm reduction strategies like widespread use of naloxone improve the long-term health effects of an overdose.

    View the original article at thefix.com

  • 6 Movies That Portray Mental Health and Depression Realistically

    6 Movies That Portray Mental Health and Depression Realistically

    Movies have the power to shape how we perceive the world. Here are several films that treat mental illness respectfully and honestly, instead of contributing to stigma.

    Hollywood holds a lot of influence when it comes to current cultural beliefs surrounding mental illness, which is why fighting stigma should be a central tenet for filmmakers who tackle psychology and mental health in their projects. Films like Split demonize mental illness by twisting real disorders into monstrous villains. The real horror of mental illness is the pain it inflicts on the person with the disorder. Mental illness can affect those closest to us, but not in the horrifying ways portrayed in Split. The movies in this list are all successful in accurately depicting one or more aspects of mental health conditions.

    What films are we missing? Add your own recommendations in the comments.
     

    Melancholia

    Kirstin Dunst plays the leading role of Justine in Melancholia, a fantastical science-fiction film giving a terribly real reflection on depression. When I first saw this movie, I was in a severe depressive downswing. I was desperate to feel less alone in my isolation, and this movie helped. It was like a friend sitting down next to me and accepting me without me needing to explain myself.

    The story circles around two sisters as Justine prepares to be married (clearly unhappily). There are many moments that capture the listlessness of depression, such as when Justine is served her favorite meal, but she can’t taste it. Other characters try to support Justine in completing basic tasks such as bathing and eating, things that can be excruciatingly difficult for someone with depression. It touches on the compulsive urges that drive self-destructive behavior and the dull ache of depression.

    “It tastes like ashes.” – Justine
     

    What Dreams May Come

    Another fantastical meditation on the complexities of the human condition, What Dreams May Come stars Robin Williams as Chris Nielsen, a bereaved father who then dies himself, leaving his widow to her severe depression. We follow his journey through “heaven” and “hell” to save his wife who later dies by suicide. The colors in this film are out of this world, and the ideas it presents about severe depression and mental illness are beautifully depicted. There are some problematic ideas about a cure for depression, such as saving yourself to save someone else or that someone can save you from the pain of depression. But these potentially troubling aspects of the movie are overshadowed by poignant lines such as:

    “Everyone’s Hell is different. It’s not all fire and pain. The real Hell is your life gone wrong.” – Albert

    “What’s true in our minds is true, whether some people know it or not.” – Chris

    I had a hard time rewatching this movie after my own father passed away, because there is something about Robin William’s thin-lipped smile that was reminiscent of my dad’s closed mouth grin.
     

    Prozac Nation

    Released in 2001, Prozac Nation stars Christina Ricci as real-life Elizabeth “Lizzie” Wurtzel, a college student with atypical depression. The narrative connects early trauma with current depression as we see Lizzie’s traumas via flashbacks. Lizzie makes risky decisions and alienates people she once pulled close. Despite her success as a journalism student and writer for The Harvard Crimson, Lizzie can’t find happiness. Eventually by seeking professional mental health support and taking the antidepressant Prozac, Lizzie’s life stabilizes.

    “Hemingway has his classic moment in ‘The Sun Also Rises’ when someone asks Mike Campbell how he went bankrupt. All he can say is, ‘Gradually, then suddenly.’ That’s how depression hits. You wake up one morning, afraid that you’re gonna live.” – Lizzie
     

    Inside Out

    A Disney-Pixar success, Inside Out takes place in the mind of a young girl going through a big life transition. We see the complications of memory formation play out through the personification of five basic emotions: Joy, Sadness, Fear, Disgust, and Anger. We come to understand the importance of each core emotion, even Sadness. Memories are more complex than depicted in this film, but the basic premise is solid — our life experiences become memories which power our personalities. In this movie, the young girl at the center of the story experiences a breakdown of her personality until all her core emotions can learn to work together.

    “Do you ever look at someone and wonder, what is going on inside their head?” – Joy
     

    It’s Kind of a Funny Story

    Released in 2010, It’s Kind of a Funny Story is an honest portrayal of what can manifest from depression. Following a teenager after a near suicide attempt, Craig Gilner (played by Keir Gilchrist) is admitted into a hospital’s psychiatric ward. What this film doesn’t do is challenge notions about the success and helpfulness of psychiatric wards, which vary greatly in quality and care. And there’s an element of romanticism that is problematic. What this film does well is show the negative self-beliefs that can accompany depression. The film also addresses the common fears that people seeking psychiatric care experience because of the stigma around mental illness.

    “Okay, I know you’re thinking, ‘What is this? Kid spends a few days in the hospital and all his problems are cured?’ But I’m not. I know I’m not. I can tell this is just the beginning. I still need to face my homework, my school, my friends. My dad. But the difference between today and last Saturday is that for the first time in a while, I can look forward to the things I want to do in my life.” – Craig
     

    Helen

    Helen is a 2009 film starring Ashley Judd as Helen Leonard, a college music professor living with severe depression. What is particularly poignant about this story is that it captures the irrationality of depression. There is no trigger, there is just depression. No matter how many times someone asks “why?”, there is no answer that fully explains the underlying causes of depression. From an outside perspective, Helen’s life seems wonderful and successful. Feeling like you have no good reason to be depressed is a common experience for many people with depression. No amount of self-flagellation helps ease the pain, and we see that played out in this movie as Helen spirals.

    “Your wife is not unhappy, Mr. Leonard. Your wife is ill.” – Dr. Barnes

     

    View the original article at thefix.com

  • 8 Super Relatable Songs About Addiction and Recovery from the Last 5 Years

    8 Super Relatable Songs About Addiction and Recovery from the Last 5 Years

    Drug-fueled parties, overdoses, stories of survival and despair. These songs deal with all that and more.

    There are so many songs celebrating the party lifestyle “and we dancing to a song about a face gone numb” (Macklemore – “Drug Dealer” feat. Ariana DeBoo). What about songs that explore recovery from addiction? There are more than you might realize. 

    How long will it take to dispel the stigma around substance use disorders and other mental illnesses? Songs that talk openly about these issues are helping to bring awareness to the public consciousness. In just the last decade, there have been so many incredible songs written about addiction. Here are just a handful of the best songs about addiction and recovery from the last five years:

    1. Shawn Mendes – In My Blood

    Shawn Mendes wrote the 2018 song “In My Blood” as a way to open up about his struggles with anxiety. The lyrics ring true for anyone who knows the excruciating pain of trying to cope with mental illness, including addiction. The song is empowering with the lyrics “sometimes I feel like giving up but I just can’t, it isn’t in my blood.” Survivors can relate to the drive to not give up on yourself, even when it’s something you can’t explain, that it just isn’t in your blood to give up.

    I’m overwhelmed and insecure, give me something
    I could take to ease my mind slowly
    Just have a drink and you’ll feel better
    Just take her home and you’ll feel better
    Keep telling me that it gets better
    Does it ever?
     

    2. Mike Posner – I Took a Pill in Ibiza

    You might know this 2015 song in its hyped up, remixed version. The SeeB remix of this song was played in clubs non-stop and streamed over a billion times on Spotify, and its music video seen over a billion times on YouTube. The original is actually a stripped-down tune about regretful drug use, excessive partying, depression, and loneliness. The backstory of a song doesn’t dictate how it’s consumed by listeners, but this tune was basically borne from a bad trip and written as a way to process “dark and heavy emotion.”

    The song is also poignant for its mention of Avicii, who was open about his own experiences with depression, addiction, and recovery, and who died by suicide last year.

    But you don’t wanna be high like me
    Never really knowing why like me
    You don’t ever wanna step off that roller coaster and be all alone
     

    3. Calvin Harris, Rag’n’Bone Man – Giant

    Scottish DJ Calvin Harris collaborated with Rag’n’Bone Man to create the stirring 2019 song “Giant.” Giant starts off with a common thread in addiction, loneliness, and trying to fill that void with something (in this case, pills). The song itself goes on to feel empowering and hopeful. Rag’n’Bone Man sounds like he’s singing about recovery: “You taught me something, yeah, freedom is ours, it was you who taught me living is.”

    I understood loneliness
    Before I knew what it was
    I saw the pills on the table
     

    4. Demi Lovato – Sober 

    The entirety of Demi Lovato’s single “Sober” is a real-life relapse confession. She wrote this song about her 2018 relapse after six years of sobriety. Part of the message is similar to Macklemore’s “Starting Over” as she sings about letting down her fans and the challenge of being public about sobriety. Loneliness is a central tenet of addiction for many, and this song touches on that with lyrics like “it’s only when I’m lonely…just hold me, I’m lonely.”

    Momma, I’m so sorry, I’m not sober anymore
    And daddy, please forgive me for the drinks spilled on the floor
    To the ones who never left me
    We’ve been down this road before
    I’m so sorry, I’m not sober anymore
     

    5. Ed Sheeran – Save Myself

    Ed Sheeran’s 2017 “Save Myself” is about finally learning to put yourself first. Like a person who became addicted to cope with codependency, the song talks about the problems inherent in giving your everything to save another person. If we don’t take care of ourselves, we can’t ever help anyone else.

    Life can get you down so I just numb the way it feels
    I drown it with a drink and out-of-date prescription pills
    And all the ones that love me they just left me on the shelf
    No farewell
    So before I save someone else, I’ve got to save myself

    And before I blame someone else, I’ve got to save myself
    And before I love someone else, I’ve got to love myself
     

    6. J. Cole – Once an Addict

    Cole’s 2018 album KOD tackles topics like mental health, addictions, trauma, and mental illness stigma in the black community. The song “Once an Addict” explores being an addict who is the child of an addict. Those of us who have experience with a caregiver’s alcoholism can directly relate to the pain of watching someone you love kill themselves slowly; then to numb that pain, becoming addicts themselves.

    Something’s got a hold on me
    I can’t let it go
    Right
    Life can bring much pain
    There are many ways to deal with this pain (right)
    Choose wisely
     

    7. Belly – What Does It Mean?

    Palestinian-Canadian rapper Belly put together the powerful 2018 album “Immigrant.” The album includes a song titled “What Does It Mean?” This track doesn’t hold back in its honest depiction of addiction at a young age. It holds hope by talking about still being alive after having an overdose at only 16 years old.

    On God that’s the moment that they all fear (all fear)
    Look, I was only fourteen (fourteen)
    X addiction got me feeling like a whole fiend
    Sixteen, first time that I OD’d
    And I’m still here
     

    8. NF – How Could You Leave Us

    Nathan Feuerstein, better known as NF, is a rapper who often pens songs about childhood trauma and mental illness. NF’s 2016 song “How Could You Leave Us” is a heartbreaking song about losing his mother to an addiction to pills. He says in the song that he doesn’t know what it’s like to have that addiction, but he does “know what it’s like to be a witness, it kills.”

    I wish you were here mama but every time I picture you
    All I feel is pain, I hate the way I remember you
    They found you on the floor, I could tell that you felt hollow
    Gave everything you had plus your life to them pill bottles
     

    What are some of your faves? Let us know in the comments.

    View the original article at thefix.com

  • Childhood Trauma, Body Dysmorphic Disorder, and Plastic Surgery Addiction

    Childhood Trauma, Body Dysmorphic Disorder, and Plastic Surgery Addiction

    Many people who have multiple plastic surgeries are looking for self-worth, not correction of a deformity.

    Most of the time when we talk about addiction, we’re referring to the compulsive or harmful use of substances. Only one behavioral addiction—gambling—is included in the Substance-Related and Addictive Disorders chapter of the DMS 5. Other behavioral addictions require further peer-reviewed research to become categorizable, diagnosable conditions. Addictive disorders involve a lack of ability to control substance use, social problems as a result of substance use, risk-taking to fulfill substance use urges, developing tolerance, and experiencing withdrawal symptoms when the substance is removed.

    Behavioral Addictions

    We no longer define addiction solely as physiological dependence on an ingested substance. We now have better categorizations for addictions, and the medical field is regularly adding more to the list, as society is constantly changing and addictive patterns become more apparent with time and research. The crux of what causes addiction is still an evolving conversation, one that keeps circling back to trauma.

    New Hampshire-based plastic surgeon Mark Constantian believes plastic surgery can become an addiction in people who have experienced childhood trauma. Outside of moral judgements, issues of class and privilege, and other health implications, plastic surgery is a choice, and for many people it has no negative mental health effects. Then there are those who get plastic surgery and are profoundly upset even though they obtain the exact aesthetic results they originally desired. Constantian became interested in the experiences of patients who responded with profound anger and disappointment despite good results.

    He describes this category of patients as being unhappy to an irrational degree. They expressed feelings of being betrayed and felt deceived. Constantian explains that they behaved “the way people behave when they’re traumatized and then triggered back to their childhood, they start acting and saying things that would have been appropriate to their abusers when they’re five or six years old but they’re no longer appropriate when they’re 40.”

    Constantian has been practicing since 1978 and has taught in his field with a focus on nasal surgery, particularly with people who have had prior nasal surgery. Patterns emerged, and he wrote a book chronicling his findings. He found that many people who have multiple plastic surgeries are looking for self-worth, not correction of a deformity.

    Body Dysmorphic Disorder

    Plastic surgery addiction, while not a diagnosable condition, seems to exist alongside body dysmorphic disorder, a mental illness defined in the DSM 5 as “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.”

    According to Dr. Constantian, “Body dysmorphic disorder is looked at as a problem that arises out of the blue.” But that’s incorrect. “[A]ll of this starts in childhood. The family problems, the self-esteem problems are already there and it just percolates. Then you get to the teenage years and you start to compensate in some way, and you medicate the pain and it can be medicating with an eating disorder, with obesity, depression, cutting, drug or alcohol abuse. The characteristics I’m seeing are shared by all kinds of addiction.”

    People wanted to be different from who they were as children. “The original genesis of the original problem had nothing to do with the cosmetic issue.” The self-harming behaviors are fulfilling a need to soothe the loneliness and the isolation, which are the result of shame.

    Adverse Childhood Experiences Survey

    To test what he was seeing in his patients, Constantian surveyed patients using an adapted version of the Adverse Childhood Experiences survey (ACE). The ACE study is one of the biggest studies on childhood abuse and neglect and other difficult experiences, and how they affect health later in life. The ACE study has been found to be one of the best predictors of conditions in adulthood.

    Through years of neglect, abuse, or other traumas during childhood, we learn what adults are like. We learn how important we are in the world, what kind of space we occupy and how safe we are. We learn how dangerous the world is. How much we’re loved. Children learn to cope with those environments. 

    Constantian’s working theory was that if trauma works on the brain long enough, eventually it develops enough damage to create a disorder that a mental health professional can diagnose. It takes time to damage the brain to that extent. Traumatic experiences in childhood can influence an entire lifetime of decisions and alter how a person perceives themselves and the world around them. 

    Chronic unpredictable stress in childhood and adolescence can echo into adulthood with reverberations that translate into mental and physical health conditions. In Constantian’s study, he found that overall, 80% of surveyed plastic surgery patients had one or more Adverse Childhood Experience (compared to about 64% in the original study). For those with more than one cosmetic surgery, 90% had higher ACE scores than those in the original study. Emotional neglect was about four times higher. Drug abuse or alcoholism in the family was almost double. He noticed that emotional abuse was common in his patients.

    How to Prevent Plastic Surgery Addiction

    Categorizing someone as a poor candidate for plastic surgery cannot be calculated with something like the ACE score, because it leaves out a key feature: resiliency. Life changes and stressful situations arise for everyone at some point or another. Most people are able to recover from these conditions and adapt to change. 

    “Having cosmetic surgery is not a bad thing, as long as the reason for that is body dissatisfaction. As long as the person feels he or she has self-worth,” Constantian says. Lack of resilience is a huge factor in whether someone is more at risk of using plastic surgery as a maladaptive coping tool. Using the ACE study cannot rule out people not suitable for plastic surgery. Constantian couldn’t predict a patient’s trauma score, no matter how well he knew them.

    Resiliency is the ability to overcome challenges and bounce back from difficult, even traumatic, events. Resilience can be learned, although there is some evidence that suggests some people may develop resilience due to genetic and other natural factors. Children learn how to be resilient through their parents, or other caretakers. If those caretakers are unavailable, abusive, or otherwise neglectful, a child may not learn appropriate coping mechanisms and lack resiliency later in life. 

    Resilience is like the antidote to childhood trauma. Often people with strong resiliency and high ACE scores had someone in their life who created a sense of stability and support. It might have been a teacher, a religious leader, a friend’s parent, a coach. Someone who made them feel capable and loved, and could model healthy coping methods. 

    View the original article at thefix.com

  • Finding Meaning in Tragedy: Addiction, Trauma, and Activism

    Finding Meaning in Tragedy: Addiction, Trauma, and Activism

    Turning grief into activism is a powerful way to process and give meaning to the pain of traumas like the death of a loved one who struggled with addiction. It is on the heels of tragedy that we can make voices of change be heard.

    Grief is complicated, individually experienced, and universal. And humans are not the only creatures on this planet who mourn their dead. Scientists continue to debate how complex the grief of non-human animals is, but the evidence points to many species grieving the loss of their kin and mates.

    For millennia, scholars have been searching for a way to explain the depths of human grief. Plato and Socrates mused on what death and dying meant and philosophized about the grieving man. Sigmund Freud, often considered the father of modern psychology, began psychological research into mourning in his 1917 essay “Mourning and Melancholia.” In 1969, Elisabeth Kübler-Ross published her influential book, On Death and Dying. The popular five stages of grief were born from her work.

    Social Media Affects How We Grieve

    Loss can be traumatic. Whether expected or sudden, close or removed but symbolic, grief can take hold when we lose someone or something significant. We mourn and ritualize loss as a means to process it. There are culturally distinct rituals for mourning families; processing the emotions that come with grief can be guided by these rituals. These customs help us find meaning in our grief, even when we don’t consciously recognize it.

    As social media continues to become a more ingrained aspect of modern life, people are developing new rituals to mark tragic loss. The social norms of these rituals (such as posting photos, posting on the wall of the recently deceased, or sharing a status that talks about special memories) is always in flux. But one norm that is constant in the age of social media is our immediate collective knowledge of loss. There is an urgency to information and the negotiation of emotions in a shared space. This immediacy is changing the old social norms of letting some time pass before talking about causes of death.

    There is another related but distinct way people sometimes process grief, and that’s by turning tragedy into a call for activism. Smithsonian Magazine published a powerful piece titled “The March for Our Lives Activists Showed Us How to Find Meaning in Tragedy.” The author, Maggie Jones, describes the instant response students had because they knew “time was not on their side.” With on-demand information, the collective conscience quickly moves from one tragedy to the next as new headlines take over. These Parkland students were not being inconsiderate in their quick call to activism, they were creating meaning from tragedy and were bolstered by the collective grief that took shape immediately, in large part because of social media.

    The Trauma of Drug-Related Deaths

    Across the United States, drug overdose deaths have been on the rise, particularly those involving synthetic narcotics (primarily fentanyl). Overdoses caused by the most commonly used drugs are tracked by the Centers for Disease Control and Prevention (CDC). And deaths due to overdose are underreported and misclassified. The stigma that surrounds addiction and the prejudice against people with Substance Use Disorder (SUD) relegates many overdose deaths to the world of whispers and rumors.

    My life has been marked by traumatic losses due to the effects of SUD. People close to me have overdosed, some survived and some died. I’ve also lost people to complications due to a lifetime struggle with Alcohol Use Disorder. Only recently have I seen these losses become conversation starters, where people will openly talk about the battles once fought by the brave folks who lost their lives to disease. Maybe that means we’re turning a corner in addiction stigma. Maybe we’re opening the door for people to feel less shame in talking about their struggles while they still have a chance to change the course of their lives. We can pay homage to our lost loved ones by sharing their stories and removing the stigma that may have kept them from receiving the help they needed.

    Recently a person in recovery told me that their co-workers do not know about their history and they will never tell them because multiple times they have made comments like “drug addicts are scum and should be shot” and “addicts are worse than rabid dogs.” The negative perceptions of people with SUD grated on this person and fed their alcoholism in a detrimental way. They believe they are simply a bad person who does not deserve help because addiction cannot be cured. This is a falsehood perpetuated by ignorant and fearful people.

    When we lose people and we share the entirety of our memories about them, from childhood to work life, and we share the truth of their battles with addiction, we are combating these dangerous preconceptions and prejudice.

    Overdoses aren’t the only way addiction kills. According to drugabuse.gov, “drug-related deaths have more than doubled since 2000 [and] there are more deaths, illness, and disabilities from substance use than from any other preventable health condition.” SUD is a diagnosable and treatable condition that deserves as much recognition as any other health issue for which there are awareness campaigns and funds devoted to find treatments to save and improve lives. Substance use disorders have the highest mortality rate of any mental and behavioral disorder.

    Tragedy as a Call for Activism

    In a world where so many people process aspects of their grief online and where tragic events unfold live for millions of people around the world at the same time, finding meaning in tragedy is necessary for our mental health. When we experience trauma, we are at risk of developing post-traumatic stress. Trauma can manifest as a strong psychological or emotional response to a distressing or disturbing event or experience. We can be traumatized when we lose someone; we can even be traumatized when we hear that someone we care for went through a terrifying ordeal. If our ability to cope is overwhelmed, that is trauma. When someone develops post-traumatic stress disorder (PTSD), their sense of self in relation to the world around them has become damaged. Trauma has the potential to shatter our beliefs about our place in the world and our sense of safety.

    Finding meaning in tragedy can go a long way in preventing the development of post-traumatic stress and can be a marker in recovery from PTSD.

    In our changing experience of bereavement, tragedy is a call for activism. It is on the heels of tragedy that we can make voices of change be heard. Tragedy creates space in which people listen. Frequently, we want to connect with others when we experience loss; sharing grief reduces its intensity. Turning grief into activism is a powerful way to process and give meaning to the pain of traumas like the death of someone who struggled with addiction.

    View the original article at thefix.com

  • Can 12-Step Programs Treat Dual Diagnoses?

    Can 12-Step Programs Treat Dual Diagnoses?

    Effective treatment needs to include both the substance use disorder and the co-occurring disorder in an integrated approach because the two conditions build on each other.

    Thirty-three percent of people with mental illness also have a substance use disorder (SUD); that number rises to 50 percent for severe mental illness. Fifty-one percent of people with SUD have a co-occurring mental health disorder. Effective treatment needs to include both the SUD and the co-occurring disorder in an integrated approach because the two conditions build on each other. People with mental illness may turn to substances to alleviate symptoms and severe substance misuse can cause lasting psychological and physiological damage.

    12-step programs are free, prolific, and available throughout the world. These mutual-help organizations are designed to facilitate recovery from addiction, but are they suitable for treating the large segment of people with addiction who also have other mental health conditions or psychiatric diagnoses?

    A 2018 meta-analysis  undertook a literature review on 14 years of studies related to dual diagnosis and Alcoholics Anonymous (AA). This extensive quantitative look into the effiicacy of AA for people with dual diagnosis found that participation in AA and abstinence “were associated significantly and positively.” The research supports the clinically-backed notion that an integrated mental health approach that encourages participation in mutual help programs is the best approach for treating patients with comorbid SUD and mental illness.

    Does it Depend on the Dual Diagnosis?

    There is enormous variation in mental illnesses, so does the potential effectiveness of 12-step programs change based on the type of disorder or diagnosis? The co-founder of AA, William Wilson (known as Bill W.), was afflicted with a co-occurring disorder. Wilson struggled with “very severe depression symptoms” and today his mental health issue may have been diagnosed as major depressive disorder.

    A study published in the Journal of Substance Abuse Treatment followed 300 alcohol-dependent people with and without social anxiety disorder who went through hospital-assisted detox followed by participation in AA. Social anxiety disorder is characterized by an intense fear of being rejected or disliked by other people. This study found that there was no significant difference in relapse or abstinence rates between the two groups and concluded that social anxiety disorder was “not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.”

    Do Sponsors Matter?

    People with dual diagnoses tend to participate in 12-step programs like AA as much as people with just SUD and receive the same benefits in recovery. Those people with co-occurring conditions may actually benefit more from “high levels of active involvement, particularly having a 12-step sponsor.”

    In many 12-step mutual help organizations, people enter into an informal agreement with another recovering person who will support their recovery efforts and hold them accountable for continued sobriety. This one-on-one relationship of sponsor and sponsee has been compared to the “therapeutic alliance” that is formed between patients and their clinicians. The therapeutic alliance is positively correlated with treatment outcomes and abstinence.

    The therapeutic alliance is one of the most important aspects of effective psychotherapy, as it helps the therapist and the patient to work together. The relationship is based on a strong level of trust. Patients need to feel fully supported, and know that that their therapist is always working towards the best possible outcome for the patient. In the sponsor-sponsee relationship, a similar level of trust and belief is essential if sponsorship is going to be beneficial. 

    As with therapy, it may take many tries with many different people to find the right fit. Not all people are suitable to be sponsors and not all sponsorships go well. A sponsor is generally expected to be very accessible to their sponsee, and available at any time, day or night. They are supposed to help with completing the 12-steps, and they often provide advice and suggestions from their own experiences. It’s a lot of responsibility.

    A strong therapeutic alliance has been found to be an excellent predictor for treatment outcomes. Does that mean a failed therapeutic alliance could derail treatment? In short, the answer is yes. Trust is critical to healing from any mental illness.

    Trauma and the Therapeutic Alliance

    Traumatic events have a serious impact on mental health. People with mental illness are at a higher risk of being further traumatized and people who are traumatized are at a higher risk of developing mental illness than the general population. Childhood trauma “doubles risk of mental health conditions.”

    Recovery from trauma is based on empowering the survivor and developing new connections to life, including re-establishing trust. Judith Herman, a leading psychiatrist specializing in trauma is adamant that recovery is not a solitary process. This may be why 12-step programs have been successful in helping some people recovery from trauma. 

    Being a sponsor to someone who has been traumatized requires a fine balance between listening and giving space. Herman explains that survivors need to know they’re being heard when telling their story. At the same time, “trauma impels people both to withdraw from close relationships and to seek them desperately.” Meaning that when the sponsor does not go away, their motives may seem suspect in the eyes of the survivor. Yet, if the sponsor doesn’t stay, it can reinforce negative self-appraisal and stoke a fear of abandonment.

    Individuals with psychological trauma can struggle to modulate intense emotions, such as anger. A sponsor or therapist has to have healthy boundaries with a sponsee/patient if the relationship is going to work. Providing good sponsorship is a huge undertaking that requires a firm commitment.

    The good thing about the 12 steps is that they are considered a long-term program which encourages revisiting the steps many times to sustain successful recovery. This is useful in terms of trauma recovery because most trauma is never fully resolved. A traumatized person will likely experience reappearance of symptoms; traumatic memories can surface in different stages of life. Stress is a major cause of these recurrences and having a place to process these events as they come up is important.

    Do 12-Step Programs Have a Role in Treating Dual Diagnoses?

    Integrated holistic treatment that addresses how the two conditions interact and affect each other will provide the best outcomes. Ultimately, what we want is to improve quality of life and to return to ordinary life with an open door to future support when necessary. The research shows that when the principles of 12-step programs are integrated with other treatments, we see improvements in self-esteem, positive affect, reduced anxiety, and improved health.

    Further research is necessary to compare 12-step programs with other emerging mutual and self-help organizations, as they have been around for less time and there are fewer published studies on their efficacy. 

    View the original article at thefix.com

  • I Don’t Always Feel Better After a 12-Step Meeting

    I Don’t Always Feel Better After a 12-Step Meeting

    Why would someone continue to go to something that they don’t always like and don’t feel immediate relief from? I’m playing the long game.

    I can’t seem to figure it out, the sinking feeling in my gut, the feeling that I am too visible, too likely to be ogled and leered at by some man old enough to be my father. What the actual hell is this feeling in my gut? I call it a homesick feeling. Maybe it is something else entirely, but it makes me want to cloak myself in a protective layer, strip myself of sexuality and erase the sexualized parts of myself. I feel a deep shame and am overcome with a sorrowful lonesomeness as if a hole has cracked into existence and swallowed me whole. I feel stripped naked: Too visible. Too human. Too vulnerable.

    It happens almost every time, at almost every 12-step meeting. I want to disappear. There is a black hole in my gut, a homesick longing that begs me to give in, and I would, if I knew what it wanted. I fear it wants to swallow me whole.

    An Emptiness Inside Me

    I don’t always feel better after attending a recovery group meeting; sometimes at the end I feel worse than I did before I got there. I don’t share the experience of always feeling supported and comfortable that seems to echo through the rooms. At nearly every 12-step meeting, someone invariably says, “When I walk into the rooms, I feel immediately at ease and at home.” 

    Well, I don’t.

    There are times when the entire affair goes swimmingly. I’ll laugh and relate and feel at ease. I will connect to other people’s shares and fully articulate my own. It will all be very nice and fun. It will feel really good, on all fronts. Then, as soon as I leave, a pit in my stomach opens and I can feel myself falling in. Other times the aching lonesomeness begins as soon as I step inside the room.

    Dangerous Adaptability

    I survived my life because I could change according to outside circumstances. It has always felt dangerous to do anything other than adapt. For much of my life, it was dangerous.

    From my adaptations have sprung multiple versions of me. Other people are privy to the Light-Hearted Jokester and the Loud and In Charge Diplomat. Being honest when sharing about my experience with addiction and recovery means another part of myself might become visible. I have spent a lot of time with Depressed Me and revealing her is scary. The Quiet One fears she makes people uncomfortable with her silence. She’s acutely aware that she is not the Jokester and doesn’t want to be noticed and doesn’t want to slip into Depression in public.

    My defenses are up in spaces where I’m allowing unvetted people to know something real about my life. I begin to feel unworthy and not good enough: proof that my worst enemy is my own mind. My instinct tells me: Don’t reach out for a while. Don’t be early for the meeting tonight, go late to avoid chitchat and leave early. My brain fills with excuses to avoid discussions and socializing.

    Getting to know me means you may grow to understand who I am in all my contradictions, which will make it harder for me to adapt. I know that facilitating communication between all of myself is necessary for healing. But the truth is, sometimes it’s really difficult. It’s difficult to be seen, to be open. Yet each time I attend a meeting, that is exactly what I’m doing. I’m expressing myself with complete honesty. I am trusting the process, despite my fear and discomfort.

    I can no longer neglect the parts I’ve long tried to keep hidden. Together we must heal. Together is the only way we can heal.

    Playing the Long Game in Recovery

    Why would someone continue to go to something that they don’t always like and don’t feel immediate relief from? I’m playing the long game. Seeking immediate relief is what I did in active alcoholism. In recovery, I’m learning to resist that behavior. 

    Over time I have seen the subtle and dramatic improvements in my mental wellbeing and quality of life. I can see the changes in my life outside of those meetings. The people around me notice my rediscovered joy, my grounded perspective, my newly formed boundaries. I go to the meetings because it’s part of a treatment plan that works for me. It’s a commitment I made to myself. A commitment to heal from trauma, because I deserve to experience a better life than I once lived. 

    I feel inspired by the possibility that if I keep trying, the healing work will be able to fill the hole that is always there; the emptiness which has eternally been ebbing and flowing in strength, making me happy and fearful in turn. I’m aiming for a stable emotional baseline. 

    It’s not going to happen overnight, but it is happening over time. The inspiration itself comforts the sorrow.

    Progress Not Perfection

    When I first got sober, I was in a very dark place. I was trapped in my own head and despite having survived everything, I couldn’t feel safe. I could only feel the pain from the past. I thought I was alone. I believed I was too broken, too sick, too lost. Finding anyone else who could truly understand what I was going through seemed out of the question. I didn’t think I was unique or special in my pain, I just believed I was hopeless. 

    Then I found a therapist, a psychiatrist, and 12-step meetings. All of which worked in tandem to lead me from the darkness.

    Today I’m not feeling that despair or sorrow. I feel content more often than I feel abject depression. I used to cry every single day and now I laugh every day. I used to swing from one overwhelming emotion to another, with no control over where my mind was taking me.

    Climbing out is an ongoing effort, but what kept me down—one of many things—was that I expected myself to be just be “better.” I thought I had to be different than I was. I now accept that this is hard work, but the results keep me doing it. It isn’t supposed to always be easy. I have to continually work on dismantling the defensive walls that have become maladaptive in their formations. 

    So, I let myself be, I take breaks to enjoy the view that is coming into perspective as the stones of my fortifications are disassembled. Sometimes I get scared, and put back a stone that was particularly heavy, afraid to lose such a significant tool of protection. That’s okay, too. I try not to judge myself. It’s a journey of progress, not perfection.

    View the original article at thefix.com

  • Letting Go of Control: How I Stopped Trying to Force Solutions

    Letting Go of Control: How I Stopped Trying to Force Solutions

    Recognizing that I am not responsible for and cannot fix other people’s feelings is powerful; it frees up so much space and time for me to do my own healing and growing.

    When I was a little girl, I remember becoming so overwhelmed with feelings that I would send myself to my room until I could cry through enough of them to clear my vision. If I got in a fight with someone, I would write an apology note and beg them to take it off my hands. I didn’t seek to understand who was at fault, I only wanted to ease the uncomfortable tension. I was sorry it happened and I wanted to undo it. I needed to erase it, but I could rarely get the resolution I was so desperate for. Adults told me: “Not everyone is ready to resolve a conflict as quickly as you.”

    No one told me: “It’s not your responsibility; you cannot fix it.”

    I respond too strongly to my perception of others’ reactions. I always wonder if I read physical and social cues too strongly. I consider the presence, the look, and the tone of voice more important than the content of what they’re saying. Maybe I’m right in my assumption, maybe I’m wrong, but if someone doesn’t want to tell me how they’re feeling, I can’t make them.

    I have lived the majority of my 32 years on earth in this way: A conflict arises and all I want is for the issue to go away and be resolved immediately. If it isn’t fixed, I feel my world is collapsing and I freak out. I cry and panic and become desperate for resolution. My mother recalls that I was predisposed to such behavior in my very early years. She told me that even as a toddler I had these panicky freak-outs.

    I hate the idea of causing hurt feelings, and particularly disappointed feelings, in others. But other people are often more well-adjusted and can handle the blows of disappointment as easily as a ship rises over a large swell. It’s not comfortable, but it’s a normal part of the ups and downs of life. Yet I’ve always handled it like my ship is about to wreck. I know I’ve had feelings of being over-sensitive and disappointed from a very young age. I didn’t want anyone to be mad at me, ever. It’s a part of how I’ve always understood or misunderstood the world.

    I never knew any other existence. I didn’t know that I didn’t have to force a solution. I didn’t know how to balance emotions—I didn’t see it as a possibility.

    My feelings run deep and the current is disproportionately strong. I am headstrong and emotionally reactive. I struggle with the tendency to overreact, but life is not as dramatic as I make it out to be. There are times when I need to be reminded of the true proportions of what is happening, so I can weigh them against my feelings and try to cut some of the excess heft. I’m not exaggerating my feelings; I feel so intensely and so deeply that learning to balance myself in a world that does not feel this way has been a lifelong challenge.

    Imagine a life full of dramatic conflicts, and you can never control the level of your emotions; they always overflow or break the dam. Joy is out of this world happiness and sorrow is the deepest despair. But the ups and downs are consistent and the rocking from one to the other is comforting because it’s familiar. Then, after decades of this you begin to feel different. It’s not overnight and it isn’t that the pendulum has stopped the perpetual swinging. But you feel different, as if now there’s more light than dark. You realize you can feel angry or anxious or sad without flooding or sinking.

    That’s me, right now. I feel generally content and I don’t know what to do with it. The mellow ups and downs of a content – even happy — life feel too safe. Part of me is waiting for the next massive swell. Of course, something will happen, that’s life, but this normalcy that feels so good can sometimes feel so strange. It’s like waking up in a new home and forgetting, for a moment, that you moved there.

    I still struggle with feeling responsible for everyone’s feelings. And the feelings I have are not just imaginary: I might sometimes actually be left out, or I might sense someone else’s sorrow. Someone might dislike me and I might realize it. When I sense tension, it might not be a delusion, but my awareness of it doesn’t mean I’m responsible for it (or for fixing it). Making someone like me isn’t my job. I am not here to be an emotional sounding board for everyone who is suffering.

    Recognizing that I am not responsible for and cannot fix other people’s feelings is powerful; it frees up so much space and time for me to do my own healing and growing.

    My life was so filled with panic and fear; that panic of needing to resolve the issue immediately. I felt that way in any interpersonal conflict, whether real or imagined. I had to force a solution. I felt as if my worth was intrinsically tied to the other person’s acceptance of me. This set the stage for an abusive relationship where the other person never validated me, which further reinforced my own negative self-image.

    I have been discovering my own sense of serenity over the last five years. I started going to therapy and then to a psychiatrist and then to a 12-step program followed by two other step groups. The combination of these different sources of support has changed my life. I don’t feel such intense panic over real or imagined conflict with others. I still feel anxious sometimes, but my response is much healthier. I am becoming more capable of controlling my behavior and my reactions, even when the feelings linger. I can usually put my well-being first and don’t follow through when I get the impulse to explain and rationalize my behavior to others.

    You can’t change other people; you can only do something about your own perspective. I always had the capacity to do that, I just hadn’t acquired the coping tools to handle my own feelings and respond to others.

    View the original article at thefix.com

  • How to Manage Depression: 6 Simple Reminders

    How to Manage Depression: 6 Simple Reminders

    Treat yourself with gentleness and forgiveness. With every negative thought about yourself, throw in a dose of self-love. Self-compassion can reduce the severity of depression and anxiety.

    Depression is not easy.

    If depression is new to you, or coming back after a long absence, you need to give yourself time and patience to adjust to new ways of being. I’ve had depression most of my life, but I am learning to live differently than I once expected myself to. Even though it may feel strange and uncomfortable, try to be kind to yourself and give yourself space to take things slowly.

    1. Dealing with Fatigue

    I can see it begin to creep up on me. Depression, self-consciousness, low self-esteem, loneliness, tiptoeing towards me. I’m cornered and I don’t see an exit plan. At the moment, I’m still using fancy footwork to confuse and tire out those demons. Behind me, on the other side of the wall, is joy. I want to turn to that entirely, but a wall separates us. It’s exhausting.

    A feeling of deep tiring sorrow is just one possible symptom you may experience with depression. For me, fatigue is a debilitating part of my daily life. It’s constant and powerful. Even when everything else is good on a particular day and my symptoms are minimal and I feel joyful, I will still be tired. My heavy fatigue makes everything more difficult to do.

    Part of practicing self-care is that I don’t fight the fatigue; I accept it and adapt. Instead of trying to force myself to do what my body cannot, I adjust my tasks and expectations of myself to better suit my abilities.

    2. Occupy Your Time

    And now I’m stuck here, me and depression. I can’t look directly at it. But it senses my weakness and fear. My defenses are down. I want to go on the attack and Charlie’s Angels my way out of here. But fear keeps that thought bubbling just below the surface, it remains ideation and not action. I turn every which way, eyes darting here and there. Nothing stays in focus longer than a few seconds.

    To deal with the short attention span, I find it helpful to occupy myself with a variety of distractions. Find things to do that can take up your time, whether that’s sleeping a bit more or watching television or playing a game on your phone. Maybe pick up a book, or work on something with your hands. Music can be very soothing. There are times when I’m experiencing sensory overload and have to stop completely, but usually even then if it has the right tempo and volume and no words, music can help.

    3. Breathe

    Depression is growing bigger, having eaten Alice’s fantasies. It’s the demon in Spirited Away, gluttonous for pain. Now my head hurts and I can’t remember what I did in the past to get out of this corner. I sink to the floor, close my eyes and take several deliberate breaths. In and out, focusing only on that breath. When I open my eyes, I can see a sinister troll cackling behind Depression.

    Depression’s troll tells me that I don’t know who the girl smiling in my photos is. That the joyful image I sometimes portray isn’t me. Depression tells me, “You don’t know where that joy is, what a facade. What a phony getup.”

    When the anxiety that often accompanies depression rushes in, what helps me (even when it helps only a little) is to take a few seconds to just remember how to breathe. In and out, deep and slow. If I can close my eyes for those few seconds, even better; thinking just about the breath. Sometimes it helps a lot, sometimes it provides only those few seconds of relief; either way, it presses pause on everything else and lets my body relax for a moment.

    4. Accept Yourself

    When I get closer, not to examine but because I am no longer running away from it, I can see my depression for what it really is. It looks ridiculous, rubbing its hands together like a cartoon villain. I push myself up off the ground and walk up to Depression. I want to make it cower in terror, but when I stand up it shrinks down and the costume falls to the floor in a heap. I can see the air pump in the back that was blowing it up to such a size. Then I notice the heart of the facade is not a demon or a monster. It’s a sad little girl who looks just like me, maybe she is me. Her armor has been taken away and she is vulnerable. She looks at me with fear.

    I swear one of the most common inspirational phrases in a Pinterest black hole is “Let it go.” When it comes to depression, I don’t know if letting go is as useful of a strategy as acceptance. They’re distinct routes to finding contentment. Moving on from a painful feeling or experience requires the ability to process memories and have healthy emotional control. Letting go implies that you can “get over it” and move forward. Someone who has depression cannot just “let it go.” Depression is a diagnosable medical condition. It affects many more aspects of life than just emotional. Some symptoms can severely impact quality of life.

    Acceptance, on the other hand, is a powerful tool that people with depression can actually use. My negative feelings are recognized and the sad thoughts that come in are not to be trusted as the whole truth, they’re just there because I have this condition. Acceptance takes away some of depression’s power. Resisting depression is exhausting and doesn’t make it disappear. But practicing acceptance changes the lens through which we see our depression, making it more manageable.

    5. Practice Self-Compassion

    Should I destroy her, now that I’ve emerged the victor? No, I won’t do that. She needs love. I don’t embrace her in a hug, not yet, but I do walk up to her and bend down to her height. I want to tell her something, but no words come, so I just give her a small kind smile. We will get to know each other. She will see that everything will be okay, and I will see pain at its correct size, not in its monstrous manifestations.

    Be compassionate with yourself. Without self-compassion we can spiral so quickly and we only prolong our own suffering. Self-compassion is a continual process that can be started over at any moment. It simply means being nice to yourself. Treat yourself with gentleness and forgiveness. With every negative thought about yourself, throw in a dose of self-love (even when you don’t believe it). Dis-identify from your thoughts.

    Self-compassion can reduce the severity of anxiety disorders, depression, and improve success rates of sobriety. Researchers have found that self-compassion lowers how harshly we judge and criticize ourselves. Mindfulness inspired the notion that self-compassion may be an effective therapeutic tool and self-compassion is like a stepping stone for practicing mindfulness. This is critical for people who blame themselves for their own suffering, since a lack of self-compassion perpetuates an unhealthy cycle of self-hate and aversion to treatment (i.e.; why get treatment when you don’t think you deserve it?).

    6. Love Yourself and Your Depression

    This isn’t some emo quote on MySpace, it’s a simple piece of advice that can bring around positive results. Loving your depression doesn’t mean you love feeling this way, but it means you accept your current reality and are willing to feel it. Feel what you feel. Accept what you feel. Love yourself and your feelings. I know firsthand the changes that can come when you stop fighting yourself and start loving yourself, in all your manifestations.

    Please share your tips for dealing with depression in the comments.

    View the original article at thefix.com

  • Are the 12 Steps Safe for Trauma Survivors?

    Are the 12 Steps Safe for Trauma Survivors?

    When the 4th and 5th steps are done without support for the symptoms of PTSD, they have the potential to retraumatize.

    Trauma is a current buzzword in the mental health world, and for good reason. Untreated trauma has measurable lasting physiological and psychological effects, which makes it a public health emergency of pandemic proportions. Trauma is an event or continuous circumstance that subjectively threatens a person’s life, bodily integrity, or sanity, and overwhelms a person’s ability to cope.

    PTSD and Substance Use Disorder

    Post-traumatic stress disorder (PTSD) is a condition caused by experiencing or witnessing a traumatic event. Symptoms include nightmares, flashbacks, anxiety, intrusive thoughts about the trauma, hypervigilance, and avoidance of triggers which remind you of the event. Substance use disorders (SUD) are frequently co-morbid (co-occurring) with PTSD. Many people with PTSD self-medicate with mind-altering substances to alleviate symptoms but getting high or drunk only works for so long. Substance use disorders often evolve from using substances as a maladaptive coping tool.

    There are many physiological correlations between psychological trauma and SUD. For example, there are similarities in gray matter reduction for both the person with PTSD and the person with an alcohol use disorder. Although the neural mechanisms of addiction in PTSD patients are not fully understood, research has found that in the prefrontal cortex, dopamine receptors may be involved in both conditions. Memories related to fear and reward are both processed with the help of these specific receptors. It could be that the processing of traumatic memories affects the dopamine receptors, making them more sensitive to reward-triggering substances.

    Sometimes, people with a dual diagnosis of addiction and PTSD find their way to 12-step programs like Alcoholics Anonymous. These programs are widespread, free, and require no commitment, which makes them more accessible than other types of treatment. AA’s worldwide membership and lasting existence has caused the program to be of interest to researchers for decades. Previous research has found positive correlations between AA participation and abstinence. There is less research on how 12-step programs interact with trauma recovery.

    Studies on relapse factors have found that common predecessors to relapse in adults include anger, depression, and stress, among others. Recalling traumatic experiences, for someone with PTSD, can cause intense physiological and psychological reactions characterized by these same feelings: anxiety (stress), depression, anger, and frustration. It’s a combination that puts people with both trauma and addiction at a higher risk of relapsing.

    Guilt, Shame, and AA

    There are two sets of steps in 12-step programs that involve memory recall and direct involvement with others: Steps 4 and 5 and Steps 8 and 9.

    Step 4 says: “Made a searching and fearless moral inventory of ourselves.” That step is followed up by sharing that inventory in Step 5: “Admitted to God, to ourselves and to another human being the exact nature of our wrongs.”

    Later, Step 8 says: “Made a list of persons we had harmed, and became willing to make amends to them all.” To deal with that list, Step 9 directs people: “Made direct amends to such people wherever possible, except when to do so would injure them or others.”

    The gist with these steps is that they look at both the resentment/anger the person feels towards others (which always involves taking responsibility for part or all of the event that caused the resentment and anger), and also the “harms” the person caused others. But there is no direct guidance on how to ensure a realistic and safe assessment of past events is made. The AA book presents this step as if someone with a substance use disorder has the tendency to blame others. People with PTSD are wracked with self-blame, and it is self-blame and shame which fuels many people’s addictions, but shame is not explicitly addressed in the steps.

    Guilt is very commonly experienced by people with PTSD. Survivor guilt can be a bit of a misnomer; PTSD develops from situations that are subjectively experienced as traumatic, but these circumstances don’t have to involve death (although they certainly can and do for many people). Simply surviving can feel like something the person is not worthy of. They may feel guilt when they don’t stay in the pain and anxiety.

    Shame is also common in trauma survivors, especially in people who have been sexually assaulted. Trauma survivors must restore a positive sense of self to find healing. Judith Herman, the author of Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror, explains that “the survivor needs the assistance of others in her struggle to overcome her shame and to arrive at a fair assessment of her conduct.” It becomes important, as the trauma reveals itself, to see it clearly for what it was so the person can integrate those experiences into their individual life stories.

    AA literature is very focused on decreasing ego and on disrupting the selfishness of the person with the addiction. This is not necessarily a helpful baseline for traumatized folks; it can be harshly critical. The feeling of being judged can deepen the rift between the survivor and others. Herman writes, “Realistic judgements diminish the feelings of humiliation and guilt. By contrast, either harsh criticism or ignorant, blind acceptance greatly compounds the survivor’s self-blame and isolation.”

    The primary text of Alcoholics Anonymous (the “Big Book”) suggests alcoholics review their past sexual life when creating a life inventory in Step 4. For the overall inventory, the book suggests that the reader completely disregard “the wrongs others had done” and to look only at “our own mistakes.” Even in situations where a person caused harm to the reader, the reader should “disregard the other person involved entirely” and find “where were we to blame?” These suggestions can be dangerous for survivors of intimate partner violence or child abuse who have been told that they were to blame for the abuse they suffered.

    The book further details what to ask yourself when making an inventory of your sexual conduct:

    “Where had we been selfish, dishonest, or inconsiderate? Whom had we hurt? Did we unjustifiably arouse jealousy, suspicion or bitterness? Where were we at fault, what should we have done instead?” It is worrisome that a sex inventory is taken to find out how “we acted selfishly” when one-third of women and one-sixth of men have been sexually assaulted or raped. An estimated half of women who experience a sexual assault will develop PTSD. One study found that 80 percent of women with SUD who seek inpatient treatment have been physically or sexually assaulted and nearly 70 percent of men have experienced either physical or sexual abuse.

    How the 12 Steps Can Harm People with PTSD

    Because remembering past traumas makes the brain’s reward center more receptive to the effects of drugs, Steps 4 and 5 need to approached with extreme caution for people who have experienced trauma. Ideally, these steps jumpstart healing; but when they are done without support for the symptoms of PTSD, they have the potential to retraumatize. As the person shares their trauma with someone else, hopefully the listener is compassionate and willing to point out where things were not the addict’s fault—at all. A child survivor of molestation had no agency in the assault, and it is unconscionable to tell that child, now grown, that they need to determine where they were at fault. It is not possible to “disregard the other person involved entirely” when an event only occurred because of the other person. Sometimes we need to recognize this fact and say to ourselves (or hear from someone else): “You had no part in this, you were a victim at that time.”

    In Steps 8 and 9 we are to list and resolve harms done to others. If step 4 and 5 didn’t properly address where our fault doesn’t lie, we may be inclined to list abuses and harm done to us as wrongs we did. It says not to make amends if it will cause harm to others, but we need an additional specification not to make amends if it will cause harm to ourselves. If you owe an abusive ex-partner money, are you supposed to pay them back if you’ve cut off all contact? These are issues that require careful consideration. Sharing both lists with a compassionate person has the potential to help survivors recover. Sharing both lists with someone who is too harsh in their suggestions and assessments has the potential to push those in recovery back into active addiction.

    The care of a loving, compassionate, and knowledgeable supporter, like a sponsor, can help sort out these dangerous triggers. Since such a large percentage of people in 12-step programs have experienced trauma, sponsors should be able to provide trauma-informed care; otherwise, going through the steps may end up retraumatizing their sponsees and leaving them vulnerable to relapse. Yet, there are no qualifications for sponsorship, and no way for someone new to the program to be aware of these potential pitfalls. There are so many variabilities to the 12 steps and how they are implemented. The way in which someone interprets the language of the steps can change how people understand themselves and their history. Trauma-focused recovery can be lost in the mix and deserves more explicit attention.

    View the original article at thefix.com