Treat or not to treat... what was the question

Treatment for addiction and mental illness typically consists of short term counseling and long term medication. Isn’t this backward.  

Many treatment centers for addiction are now called integrated treatment or dual diagnosis to treat concurring disorders.  In other words, individuals with substance use conditions often have a mental health condition at the same time, and vice versa.  We now know, many addicts struggle with mental illness, such as depression and anxiety.  In many cases, this is the proper treatment, but in some cases it is a diagnosis just to get paid.  We all know insurance bills get inflated because insurance companies will pay for some treatments and not others.  Treatment has become what will the insurance company pay for and not what is best for the patient.

The big issue with long term medication protocol is the medication dampens everything, not just the depression or anxiety.  They may help with depression and anxiety, but they also impact the pleasure center of the brain, many patients say they feel like a zombie.  Medicating a patient doesn’t deal with the root cause of their mental illness or addiction.   Treatment should be about making people well, not suppressing the underlining cause or trading addiction.  

Take Suboxone for example; it's like Methadone, where people stop using heroin and are prescribed Suboxone by a doctor to alleviate the withdrawals.    The cost to the patient, without insurance, is about $500 per month.  The doctor is now in control of the addict, they are told how much to take, when to take it and when to pee in a cup.  Follow my rules or no soup for you.   Did the addict just change dealers? 

What we should be doing is treating people to get them to a point where they can stand on their own two feet, dealing with the pain of life, using tools they have learned to be able to deal with the pain, anxiety and disappointment. 

Treatment should have a short term and long term goals with milestones customized for each

client.  Treatment is not like making sugar cookies. Each client is different, and they have different needs.  The treatment professional should work with the client to define what can be accomplished in three month increments, over two to three years so it heals and changes habits and behaviors. The use of technology can reduce the cost and help manage the goals and milestones.  If the treatment is tiered the client can begin to get their life back and not be chained to their treatment.  

Addict... Label or Diagnosis

Redefine addiction and not let it define the addict

There is a stigma and for many a sense of shame associated with addiction.  Where did it come from, was it created by the industry or the addict?  Webster says a Stigma is a set of negative and often unfair beliefs that a society or group of people or a mark of shame or discredit.

Now that an addict has decided to seek treatment they deserve support not shame and why do they need to keep introducing themselves as an addict?  I am not sure this is a good idea, how does it help their recovery? Think about it. When they go to a recovery meeting they are told to introduce themselves and say “Hi my name is Dave and I am a drug addict” or “Hi my name is Sally and I am an alcoholic”.  Sure, when you decide to get help you do need to admit you have a problem and that you are an addict.  We all know this is the first step in recovery and is the most important step.  

Why do you need to keep labeling yourself?   Are they perpetuating the stigma of addiction or are they standing up loud and proud?  There are still those who still believe an addict is just morally flawed, just weak and should “just say no”.  We now know it’s not a weakness and science proves it is a disease and now the only question is; what caused the disease and addictive behavior.  Was it caused by nature, nurture or both?  We already know hereditary traits play a role in addictive and compulsive behavior.  We also know our environment can have a dramatic and long term effects on our brain and can trigger these behaviors.  The effects on the brain of being neglected and abused are undeniable.  This was illustrated by the Adverse Childhood Experiences (ACE) study at Kaiser Permanente, where they looked at childhood experiences of trauma, abuse, neglect, and family dysfunction and scored each of these experiences.  This study showed with a score of 4 or higher they were five times more likely to become an alcoholic and score of 6 or higher were 46 times more likely to become an IV drug user later in life.  These results have been supported by more than 50 scientific articles. 

Addiction is not about a criminal with a bottle in a paper bag or a needle in his arm.  It’s about the damaged child, the changes in the brain and the pain they are trying to run from or suppress. 

Listen to people around you talk about their addiction and you start to see it has become their identity or even a crutch. It’s all they know. I saw a post on the internet and it said “I’m a drug addict, I suffer with a disease called addiction.  I can’t be cured but I have learned to live with it”.  I found this very sad that she thought this was now her identity.  Recently I received a fundraiser email from a supporter of a non-profit treatment center and in the email they said “They are number 1 in the area in turning thieves into wonderful law abiding citizens”.  This may be true, but did the writer think about the impact those words have on a reader who may be struggling with addiction. I can only imagine what this said to a reader who is struggling. Is this the way society sees me? Why even try?  They may have become a thief but it’s not what they wanted to be and it’s not where they started. They started out an innocent child who was neglected, abused and hurting.

Along with the abuse they suffered they were given labels such as; stupid, moron, idiot, and

worthless, now they have a new label.  Is this a self-fulfilling prophecy and they begin to self-identify with these labels? If you hear something long enough and often enough, you begin to believe it.   The addict doesn’t need the rest of the world telling them how bad they are, they do enough of that on their own.  The media tells us what an addict should look like, you have all seen the guy on the bench with a bottle wrapped in a paper bag or the girl prostituting herself for drug money.  Is that who they really are or is it what has happened to them?  

Addicts begin to own the labels society gives them, it’s their identity.  For some, it has become an excuse not to try anymore.  Some even think... if I tell people I’m an addict they won’t expect much from me and I can get by with accomplishing less.  Don’t hold me accountable because I am defective, I have a disease.  I can’t work because I can’t handle the pressure, I might relapse.  Remember, they are hurting, depressed and without hope.

Taking it further, what if you continue to believe you are sick, will your negative thinking prolong your illness?   Dr. Chopra and Dr. Segal believe positive thinking plays a significant role in recovering from cancer and other illnesses.  So why is it any different with addiction?

I think now it is time to redefine addiction and not let it define the addict.  

Maybe we should start looking at addiction as any other disease, such as cancer.  When you are diagnosed with cancer people don’t run from you, they “Run For The Cure”, they support you, they make sure you get your treatment and even start crowdfunding for you.  Some cancers are not curable, but they can be treated and go into remission.  Once your cancer is in “Remission” people drop the label and stop treating you like you’re sick.  Then it’s up to the cancer patient to take care of their health and follow the long term treatment protocol and watch for reoccurring signs.  Addiction is not much different.  Once you have been in treatment and are in “Recovery” you can lead a normal life as long as you follow the treatment protocol and watch for triggers.

Let’s drop the labels and realize we are all struggling with something.  No need to label, enable or coddled anyone because of their illness, just support them and hold them accountable for their actions.  Addicts also need drop the label or crutch which ever they are choosing to use and focus on the positive side of recovery. They survived… 

Its about rewiring the brain and changing habits.  

What if addicts began to do what top performers do?  Athletes use positive self-talk to accomplish amazing feats of athleticism…   Muhammad Ali took it to the next level by saying... I am the greatest! I'm the greatest thing that ever lived. 

Helen Keller who was deaf and blind said Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.  

One big fish story…

One big fish story… or The path of least resistance

When talking about addiction and how it affects the brain have you ever heard the term “what fires together wires together”?  What does this mean.  The phrase, “neurons that fire together wire together” can be attributed to Donald Hebb, a neuropsychologist, who said this in 1949. 

Each time you have a thought or encounter, different areas of your brain records this information all at the same time. (they fired together and are now wired together) i.e. You will never forget the first time you touched a hot stove; what it felt like, looked like and even smelled like, because your brain remembered every detail.  Next time you see a hot stove all of those areas in your brain remember it in details.  This happens with the good things in life too. When you hear a song it can take you right back to that moment in time, the feeling and what you were doing, who you were with.  Advertisers have known this for a long time and they hit you in as many regions as the brain as they can, sight, sound, scent etc.  This way your brain associates that product in many different ways.  The more times the same thing happens the stronger these connections get. 

I like to think of brain wiring like that path down to the creek when you were kids.  When you first started to go down to the creek you had to push through waste high grass with your fishing pole slung over your shoulder.  Remember the first time you fished there and all the big fish you caught?  That memory kept you coming back time after time, using the same path.  By the end of the summer you could clearly see the path you had been taking and within a couple of years it was a well-worn path.  Every time you start down that path you remember the first big fish you caught and you say to yourself, today I’m going to catch another really big one today, but you never do.  All you have left is the memory and a well-worn path.

This is what happens to our brain when we repeat anything over and over.  We create well-worn paths and these paths are what we follow without much conscious thought, hoping for one more big fish. 

In the case of addictive behavior, it may start out as a something to distract and entertain us or ease our pain.  Then here comes that well-worn path of a habit, followed by the anticipation of what is going to happen.   That first rush is now long gone and replaced with the brains need to keep that feeling coming.  They brain starts to tell the rest of the body it needs that old feeling back…  right now and it does it rather loudly.  Then when the body grabs that fishing pole the brain begins to anticipate what is about to happen its starts the fireworks show and those neurons begin to fire much like it does when we actually engage in the addictive behavior.  People talk about the rush they get from hearing the casino noise or seeing drug paraphernalia and its almost as powerful as the addiction itself.  We now see that with the internet and smart phones; every notification on your phone brings a rush of excitement of what the message might be.

What addicts really need is help building new paths, healthy paths that lead in all new directions,

away from old thinking and friends.  If they don’t get rid of the old paths they start to think they can go fishing with their old friends just one more time.     

Our brain keeps telling us, there might be one really big fish left, I bet we will catch it this time.  Let the fish go, that one last time may kill them…