Addiction Recovery: Experience, Strength and Hope

The 12-Steps model is one of the more common roads for one to take in the journey to recover from a substance use disorder. For more than 80 years, individuals caught in the maelstrom of addiction have turned to the rooms of 12-Step recovery, such as Alcoholics Anonymous. What started as two people sharing their story with one another, overtime morphed into a program where millions of people with the disease of addiction work together to live a spiritual life free from drugs and alcohol.

We all have different stories. All of us came to the rooms of recovery by a different road. But, at the end of the day, our stories are remarkably similar. With an open mind, one can easily see that no one living with the disease of addiction (active or not) is all that unique. As much as we all imagine that we are unique, that is our addiction or our path to it was somehow special, as one’s disease would lead one to believe, at the end the day the driving forces that led to and perpetuated the vicious cycle are quite the same.

A “normal” person may try a drug on more than one occasion, and think nothing of it. Whereas, others being exposed to a substance will have a far different experience and develop an insidious relationship with drugs and alcohol due to genetic, psychological and environmental factors. If the aforementioned explanation seems ambiguous or nebulous, that is because it is; while addiction experts and researchers have a basic understanding of what precipitates an addiction there is still much that is not well understood.

 

It Doesn’t Matter How You Got Here

People who are new to recovery, will often feel an urge to at least try explaining how this happened. Where they zigged when they should have zagged. But, when all is said and done, such explanations and experiences are only of value when it comes to not repeating past behaviors. Simply put, the road that brings one to the abyss of active addiction, is not the same road you will take to recover from the disease.

We can’t walk back down the road of our past, identify where we made a wrong turn and correct course accordingly. Rather, one must forge a new path. A journey that requires not only adopting, but showing deference to the principles and traditions that have saved the lives of those who have come before you. In the “rooms,” you will be asked to share your experience, strength and hope by relaying what it was like (active addiction), what happened (how you came to the realization that one’s course was no longer tenable) and what it is like now (the transformation which resulted from living life one day at a time and practicing the principles of recovery in all your affairs)?

It may seem like an onerous task, and it is most certainly. But, through honesty, humility and continually reminding yourself that without taking these steps the outcomes are bleak. In the rooms of recovery, you are taught how to learn from your past, by living for today, so that you may have a future.

 

Giving It Away Is The Gift

It is interesting to note the transformation people undergo, as is evident by what is shared. In early recovery, one is in total disarray. In a fog of one’s own shame and regret, incessant and pervasive thoughts about how your best thinking got you here. Newcomers are still so close to their disease that to talk about anything but what it was like out there is an impossibility. But those who are willing to do the work, follow direction and are honest (even when it hurts) have a fighting chance at not only achieving long term recovery, they will be in a position to share the strength and hope—potentially aiding others in their mission to live a spiritual existence.

Many, if not the majority, of people who enter a program of recovery are hopeful that manageability will be returned. They look around at those who have significant recovery time, they hear about how those peoples’ lives have been put back together from a multitude of infinitesimal pieces. Some of whom getting their families back, holding good job, driving their own vehicle (registered and with valid insurance), etc. It can be easy to see all those things as being the gift, or gifts of recovery. However, those are merely the byproduct of the true Gift of recovery. The miracle of living a spiritual life free from the bondage of self, helping others recover as they help you recover, simply by sharing one’s experience, strength and hope. Having an active role in another's recovery is the Gift, you get to keep your recovery because you freely give it away.

Smartphones May Impact Teen Substance Use

Everyday millions of Americans of practically every demographic spend an inordinate amount of time on their smartphones. Between checking for the latest news and playing games, there are countless ways to waste time on the pocket-sized devices. In recent years, many experts have raised concerns about our reliance on smartphones. It cannot be denied that they are sometimes used to distract us from the really important life issues, whether that be responsibilities or our mental state. For some people, smartphone use turns into dependence and even addiction. With that in mind, we would be seriously remiss if we failed to mention that smartphones may actually be doing some good when it comes to drug and alcohol use.

With the United States in the continued grip of an opioid addiction epidemic, it is hard to pinpoint areas of progress when it comes to substance use and abuse, until you take a look at teenagers. Research has shown that teens are trying and using drugs and alcohol less and less over the last decade. “Monitoring the Future,” is an annual survey which essentially takes a snapshot of teenage (eighth, 10th and 12th graders) drug and alcohol use. The most recent findings indicate that past-year use of illicit drugs (excluding marijuana) was the lowest in several decades.

While education and prevention can account for some of that progress, it would seem there are other factors at play that could be responsible for the decline. Researchers have theorized that smartphones could be one of the major causes for a drop in teen substance use rates, The New York Times reports. They point out that the downswing of drug and alcohol use coincides nicely with the significant increase in smartphone use.

The director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow, has plans in the works to research the correlation between smartphones and substance use reductions, according to the article. Interactive media is, the director of NIDA describes, “an alternative reinforcer” to
mind-altering substances, “teens can get literally high when playing these games.” Dr. Volkow will share the findings with a group of scholars this spring.

Dr. Volkow’s theory is “highly plausible,” said Dr. Silvia Martins, an expert on substance abuse at Columbia University. “Playing video games, using social media, that fulfills the necessity of sensation seeking, their need to seek novel activity.”

We will continue to follow this interesting story in the coming months. Whatever the findings are, they will surely be of interest to those working in the field of addiction, or for those recovering from it. Parents will likely have a vested interest in Dr. Volkow's findings, as well.

Alcohol Legal Limit Debate

It was a long, hard fight to convince every state to come along with the National Minimum Drinking Age Act of 1984, which required states to pass individual legislation raising the drinking age to 21. Fourteen years later, under the Transportation Equity Act for the 21st Century of 1998, a Federal incentive grant was created encouraging states to set a driver blood alcohol content (BAC) limit at .08. Congress adopted .08 BAC as the national illegal limit in 2000.

Driving under the influence is a major concern in every state. Thousands of Americans lose their life every year from alcohol-related traffic accidents. Millions of dollars are spent annually to educate young people about the dangers of drunk driving, yet such efforts often fall on deaf ears. In many cases, people who get one DUI end up getting several more before the lesson is learned by serving serious jail time.

It appears with each year that passes, states attach stiffer penalties to those caught driving under the influence. How much alcohol it takes to reach .08 BAC depends on one’s metabolism, body weight and type of alcohol. But, it is generally agreed that 2 to 3 alcoholic beverages will put someone around or above the illegal limit to drive. Although, one should always keep it in the back of their mind that any amount of alcohol can impair one’s ability to drive.

Over the years, debates have been held about whether the .08 illegal per se law (meaning that the act is inherently illegal) was too strict. Or, not strict enough. It is easy to argue that a lower BAC limit would deter more people from taking the risk of driving with any amount of alcohol in their system.

The National Transportation Safety Board (NTSB) has been urging states to lower the legal limit for some time now. And, it appears that the State of Utah heard the call, poised to become the first state to implement a .05 BAC illegal per se level, according to the Associated Press. On Wednesday, state lawmakers voted in favor of lowering the legal limit, and Governor Gary Herbert is expected to sign the bill which would go into effect on December 30, 2018. Just in time for the New Year’s Eve celebrations.

The supporters of the reduced BAC limit believe it will save lives. On the other hand, some of the opponents of the bill say that it will only serve to hurt tourism and the hospitality industry, the article reports. States have been reluctant to do so because of pressure from the hospitality industry.

It will be interesting to see if other states decide to hop on this potentially life-saving bandwagon. It might be possible that dropping the legal limit will mean that people with alcohol use problems will determine that they have an unhealthy relationship with alcohol sooner. DUI sentencing typically requires one to attend 12-step meetings and diversion programs. In many cases, people that didn't think they had a problem, realize they do.

Opioid-Tax In California

The American opioid addiction epidemic has put a serious burden on society, both the human and financial costs of the crisis are staggering. It is widely agreed upon that the best shot of gaining control of the scourge of opioid abuse in America is by way of education and addiction treatment. If health experts can properly educate people about the dangers of experimenting with opioids, fewer people may follow down the road towards addiction. For those who have already become snared by addiction, science-based treatment is the most effective way to throw a monkey wrench into the gear-works of the disease.

In recent years, federal and state lawmakers have been scrambling to provide and fund adequate addiction treatment services. In many states, people often wait long periods of time to get a bed at a treatment center. There is a serious lack of treatment facilities, counselors and funding to pay for both. If you consider for a moment that there are over 2 million Americans who meet the criteria for opioid use disorder, then you can see that it will cost a considerable amount of money to ensure that they all get the treatment they need, but may not be able to afford.

When looking for the root causes of the opioid addiction epidemic, fingers will point towards over reliance on prescription opioid painkiller—more times than not. While efforts to reign in prescribing practices have been successful in a number of ways, the problem didn’t disappear because individual addiction was not addressed. Making it more difficult to acquire prescription opioids often results in turning to heroin as an alternative means of avoiding withdrawal.

So, if we can agree for the moment that treatment is the answer, then finding the necessary funds to provide it is of the utmost importance. Look no further than opioid wholesalers to finance the vital cause. Or, that is what one California lawmaker has suggested. Assemblyman Kevin McCarty (D-Sacramento) introduced a bill that would impose a one-cent-per-milligram tax on opioid painkillers sold statewide, The Los Angeles Times reports. According to KTLA, "The tax would be imposed on wholesalers who import the medication into the state, not at the point of sale, and it would require a two-thirds approval vote in the Legislature." The companies making money on the drugs people are becoming addicted to would, in effect, pay for the treatment those patients now require.

The prescription opioid business is a multi-billion-dollar industry. While the drugs do effectively treat pain as advertised, they also carry a serious risk of addiction. It is hard to argue against the pharmaceutical industry covering some of the costs of treatment in America.

“California’s opioid epidemic has cost state taxpayers millions and the lives of too many of our sons and daughters,” McCarty said in a statement. “We must do more to help these individuals find hope and sobriety. This plan will provide counties with critical resources needed to curb the deadly cycle of opioid and heroin addiction in California.”

Ocean Holds Opioid Alternatives

In the United States, we are in desperate need of opioid alternatives when it comes to the treatment of pain. It is fair to say that the problems we face with opioid addiction today, would not be so severe if opioid painkillers were not so effective. Calls to look for alternative forms of pain management have been loud in recent years, yet physicians may be scratching their heads about what to prescribe instead. Unfortunately, many pain sufferers do not respond to meditation and acupuncture. And frankly, severe pain can require the use of powerful opioids.

Those tasked with developing opioid alternatives for pain relief are researchers at any one of a number of colleges/universities around the country. But effective research requires large teams working thousands of hours. The point being, finding opioid alternatives could take years to accomplish—when we need solutions now. Nevertheless, researchers trudge sedulously to find such alternatives, sometimes looking for answers in the strangest of places.

A number of medications currently used today have their origins in the tropical rain forests of the world. But when it comes to pain management, new options may be residing in the deep blue sea. Meet Conus regius, a species of sea snail that is both predatory and venomous.

Conus regius (Credit: Zsnapper)

Researchers at the University of Utah have isolated a compound from the snail's venom that acts on a pain pathway different from the pathway targeted by opioid painkillers, GEN reports. The compound, RgIA4, was successful at blocking alpha9alpha10 nicotinic acetylcholine receptors (nAChR) pain pathway receptors in rodent models. The research was published online in the Proceedings of the National Academy of Science.

"RgIA4 works by an entirely new pathway, which opens the door for new opportunities to treat pain," said J. Michael McIntosh, M.D., professor of psychiatry at the University of Utah Health Sciences. "We feel that drugs that work by this pathway may reduce the burden of opioid use." 

The Conus regius sea snail could be vital for the development of new painkillers that do not carry the same risks as opioids. What’s more, while RgIA4 works its way through the body in only 4 hours, the pain-relieving effects of the compound were still working 72 hours after the injection, according to the article. Dr. McIntosh points out that the majority of painkillers used today are not sufficient in addressing chronic pain. Better alternatives may be found in the ocean. Really exciting stuff.

“Nature has evolved molecules that are extremely sophisticated and can have unexpected applications," says Baldomera Olivera, Ph.D., professor in biology at the University of Utah. "We were interested in using venoms to understand different pathways in the nervous system."

Depression and E-Cigarette Initiation

Last week we covered an alarming new trend regarding e-cigarette use among young people, known as “dripping.” We felt it important to keep the conversation about e-cigs going, considering the device's growing popularity among young people.

Smoking cigarettes has long been associated with a form of stress release, much like having a beer at the end of long day. Who hasn’t known someone who, when stressed out, said aloud, “I need a cigarette.” People don't just smoke when they are stressed. They smoke to alleviate anxiety and depression, as well. Some even smoke to quell their appetite, at times. Such behaviors are often what addiction is built upon, associating a specific action with relief.

In the field of addiction medicine, it is quite common for patients who report their addiction being the result of self-medicating untreated mental illness, such as depression or bipolar disorder. Such instances are referred to as co-occurring disorders. When mental illness is left untreated, people will often look to potentially dangerous remedies, like drugs and alcohol. But let’s get back to nicotine for the time being.

In recent years, there has been a heated conversation about electronic cigarettes, specifically with regard to the benefits over traditional tobacco products and the potential health risks. It is fair to say that at the end of the day researchers (in most cases) do not yet have definitive answers regarding the pros and cons of e-cigarette use. While most will agree that e-cigs are likely a safer alternative to other methods of nicotine delivery, yet there is widespread concern in the health community about the impact of the vapor devices on young people.

Concerns have also been put forth of late regarding mental health and e-cigarette use. A study conducted by researchers at The University of Texas Health Science Center at Houston (UTHealth) showed a link between depression and initiation of e-cigarette use among college students, according to a UT press release. The findings were published in Nicotine & Tobacco Research.

While the researchers could not find evidence that e-cigarette use leads to elevated symptoms of depression, the study showed that college students who had had elevated levels of depressive symptoms were at a much greater risk of starting to use e-cigs, the article reports. The relationship was surprising to the researchers because the same could not be said for the relationship between depressive symptoms and traditional cigarette initiation.

"We don't know why depression leads to e-cigarette use. It may be self-medication. Just like with cigarettes, when students feel stressed out, using e-cigarettes may make them feel better. Or it could be that since e-cigarettes have been marketed as a smoking cessation device, depressed students may be using e-cigarettes to help them quit smoking traditional cigarettes," said lead author Frank Bandiera, Ph.D., assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health in Dallas. 

The study was the first of its kind to establish a longitudinal relationship between the depression and e-cigarettes, according to the article. Further research will be needed to determine what the relationship means.

Teenage E-Cigarette Dripping

The e-cigarette conversation continues as more and more teenagers are using the devices. A 2015 survey found that 24 percent of high school students reported using e-cigarettes during the past 30 days, per the Centers for Disease Control and Prevention (CDC). While the Food and Drug Administration (FDA) has finally been given authority to regulate e-cigs, creating age restrictions, the devices are still being used by minors and young adults.

Most experts agree that electronic cigarettes are less harmful than other forms of nicotine delivery. However, nicotine is still addictive and can potentially start young people on the road to harmful behaviors that can lead to addiction. Furthermore, e-cig nicotine juices come in a number of flavors that can keep people coming back for more, where as traditional cigarettes have one flavor—you either like it or you don’t.

There have also been concerns raised about nicotine levels in e-cigarette “juices,” and how the devices are used. A new trend called “dripping,” allows e-cigarette users to get more bang for their buck, HealthDay reports. In fact, a survey shows that 1 in 4 teens have reported having tried dripping. So, what is dripping?

Normally, e-cigs users inhale to gradually draw the e-juice into a heating coil through what are known as “wicks,” creating a vapor, according to lead researcher Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine in New Haven, Conn. "Dripping" is when e-cig users place drops of the nicotine juice directly onto the exposed heating coil and then quickly inhaling the thick vapor cloud produced. Krishnan-Sarin’s survey indicates that 26 percent of student e-cigarette users at eight Connecticut high schools has "dripped."

The immediate or long term health consequences of dripping are not known yet, according to the article. Although, the chief of general pediatrics of Mount Sinai Health System in New York City, Dr. Karen Wilson, says that the more potent nicotine could impact the developing brains of teenagers.

"Adolescents should not be using nicotine at all," Wilson said. "It changes the brain chemistry, and adolescents are uniquely susceptible to the addictive properties of nicotine." 

The findings of the report were published in Pediatrics.