Author: Doug

“The truth is, we all face hardships of some kind, and you never know the struggles a person is going through. Behind every smile, there’s a story of a personal struggle.” – Adrienne C. Moore

“A lie can travel half way around the world while the truth is putting on its shoes.” – Charles Spurgeon

Today, the greatest challenge that we face in addressing the addiction crisis is not preventing the creation of new addicts nor is it getting those already addicted into lasting recovery. Our greatest challenge lies in overturning the misconceptions, the stigmas, the misinformation, and the outright lies that continue to be repeated about addiction and those suffering from it. I believe that education is the key and ignorance is the biggest obstacle. We cannot successfully attack a crisis of this magnitude unless we understand the problem and set to work using our resources where they are most effective. Please join me as I take on some common misconceptions in “Misconceptions and Stigmas Part 2”.

“Addicts are All the Same, They Just Want to…”

This statement can end in a multitude of ways such as, get high, have fun, lay around all day, avoid reality, etc. I addressed the second half of this statement in Part 1 but there is also the ridiculous concept that all people of any group are the same. Confronted with this fallacy in their statement most would retreat to saying that they are not exactly the same but the concept remains. Addiction does cause the same changes in an individual’s brain regardless of the activity or drug of choice but people with substance use disorder are as varied in their thoughts and behavior as the rest of the population.

Most people think of “addicts” as the person that they see on the street corner asking for money, living under the overpass, sleeping on a park bench or any other of a number of negative stereotypes. It is true that some people struggling with addiction do behave this way. What is also true though, is that there are lawyers, doctors, skilled laborers, people of all walks of life that are suffering from addiction to alcohol, opioids, cocaine, crystal meth, or any other abusable substance. You probably interact with people suffering from substance use disorder daily but you don’t see it.

When our son died, his employer told us that of the 20+ people that they employ he is the last one that they would suspect was an addict. I know a civil engineer that was married to a lovely woman and they had two wonderful kids, yet he was addicted to crack cocaine. In both of these cases the drug ultimately won but they were hardworking, contributing members of society. Typically, individuals that are able to hide their addiction ultimately do one of the following: get help and find lasting recovery before they destroy their lives, get help and find recovery after they have destroyed their lives, or they die from overdose or the results of the abuses that they heaped on their bodies.

Why should this matter to you? So what if there are “functioning addicts”? This matters because as long as the negative stereotypes persist people will resist efforts to help those suffering from substance use disorder. People will look down on them and refuse to accept them. Individuals in recovery are fighting a tremendous battle that lies largely within their own injured brain, they do not need additional obstacles thrown in their way. AND they likely will keep their addiction hidden for fear of the stigmas and not seek help. Addiction that is not addressed typically ends in death. That should matter to you, they are people just like you and me that are suffering from a disease that they may have initiated but it quickly overwhelmed them (physically).“Addicts Don’t Think of Anything but Their Next Fix”

In discussing addiction and its impacts on the brain, I often speak as if this statement is true. I talk of how conditioning and neuroplasticity physically change the brain, making it believe that obtaining the addictive substance or behavior is necessary for survival. This appears to indicate that getting their next fix is all that matters but that is a gross oversimplification. The truth is that when the “need” is satisfied (when the person uses), the cravings, the drive to use is reduced. It is at this time that the person with substance use disorder may be crushed with thoughts of the impacts of their behavior on those that they love. There is overwhelming regret, shame, and remorse. The response to such feelings is typically the desire to hide from them and for those suffering from addiction, that means using again. The vicious cycle of use-shame-use is obvious and nearly impossible to break because of the physical changes to the brain that reinforce the addiction.

We often see in the media stories of parents found passed out in their car while their very young children are buckled in the back seat. The obvious conclusion is that these people do not love or care enough about their children. That conclusion is almost always wrong. They love their children deeply, but they are overwhelmed by their addiction and have acted upon the need to use.

A similar conclusion causes great pain to the children of addicts and alcoholics. They frequently feel that they are not good enough or important enough for their parent to stop their addiction and this causes low self-esteem and depression. The truth is that these are two very different drives in the brain. The love that they feel for their children is no less than the love that we all feel for our children but there is another area of their brain that is requiring them to obtain the substance that they “need” to survive. No one would think that their parents loved them less if they left them for a time to ensure that there was food. The problem lies in the fact that we all know, in fact those suffering from addiction also know on a logical level, that they do not need their drug of choice to survive. BUT the primitive part of their brain, that we do not have conscious access to, is driving them to get the drug that they “need”.

Addiction is Not a Disease. They Just Call it that so Insurance Will Cover Treatment

I read this statement in a letter to the editor and I was amazed. Within this blog, I have laid out all kinds of evidence and scientific investigations that would lead most people to conclude that addiction is a disease. I know that people resist the thought that addiction is a disease. Hell, so did I until I did my research. But to think that we only call it a disease to get insurance coverage underestimates the intelligence and lobbying power of insurance companies. The treatment of addiction costs millions if not billions of dollars. Don’t you think that if insurance companies could prove that addiction is wholly self-inflicted, they would refuse to cover treatment?

Please don’t think that I am making excuses. I believe that to succeed in recovery, an addict must accept what they have done. BUT

• Addicts do not choose to continue to use, they need to use.
• Willpower will not get an addict to stop because all of the willpower that they have to stop is also being used against them by their altered brain, to protect their addiction. Likewise, there is no threat that can be used to make an addict seek help.
• If you are not an addict, congratulations you got lucky. You don’t get to look down on addicts because you were born into a healthy environment and you won in genetic roulette.
• Addicts can succeed in managing their addiction but it requires help, support, understanding, and lots of time.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

“The secret of change is to focus all of your energy not on fighting the old, but on building the new.” – Socrates

All of us who have lost a loved one deal not only with grief but with the nagging question “what should I have done differently?”.  The truth is that we will never know what may or may not have helped but that doesn’t stop those thoughts from intruding at the most inopportune times. I believe that some people are capable of learning to manage their addiction with support and structured help alone.  But I also believe that there may be people for whom addiction is too powerful and they need therapeutic drugs to help them.  Was our son one of those people?  Would he still be alive today if we had convinced him to try medication-assisted treatment (MAT)?  That is the major “what if” that nags at me.  The last post discussed Narcan and I want to follow that up with a discussion of MAT, therapeutic drugs used to combat substance use disorders.  So, please join me in this post, “Narcan and Friends Part 2”.

How does Medically-Assisted Treatment Work?

The short answer to how MAT works is that it depends on the therapeutic drug that is being used, but there is more to it than just that.  I found this excellent summary on the Psychology Today blog:

MAT is most useful when combined with intensive one-on-one psychotherapy, group support, and complementary therapies. The way in which MAT affects the brain effectively gives the addict breathing room and time to address the underlying causes of their addiction. MAT allows the addict to focus on their recovery instead of being compelled to use by co-opted neurological processes. MAT is a tool to be used in reaching that goal of long-term abstinence from drugs and alcohol. However, if MAT is used on its own, without other forms of supportive therapy, it is unlikely that recovery will last.

https://www.psychologytoday.com/us/blog/ending-addiction-good/201701/what-you-need-know-about-medication-assisted-treatment

Did you catch those two phrases, “gives the addict breathing room” and “instead of being compelled to use by co-opted neurological processes”?  Not that I think you need an explanation, but we remember things when they are stated in language that we use.  In other words, the person suffering from addiction has a brain that has been physically changed to believe that it needs the substance to survive and he/she needs breathing room from the thoughts, the cravings, the triggers, drug-dreams, etc.  The other important concept in that summary is that MAT alone usually will not result in lasting recovery.

What are the Therapeutic Drugs used in MAT?

Methadone

Methadone is the therapeutic drug/MAT that people are most familiar with.  We have seen in movies and heard in songs how a junkie goes to the methadone clinic every day to help them get off of heroin.  That is not too far from accurate. In the early stages of methadone treatment, a person suffering from addiction to opioids must go to a facility to receive their daily dose of methadone.  Methadone is a full opioid agonist, meaning that it functions by attaching to the opiate receptors in the brain and it causes a similar response.  Therefore, methadone can be abused and that is why in early stages of recovery it is only dispensed one day at a time.

Methadone is a synthetic opioid that changes the way that your brain responds to pain.  It gives your brain the same feelings that other opioids give but at a slower rate.  It also blocks the high that you get from other opioids like codeine, heroin, hydrocodone, morphine, and oxycodone.  In short, methadone tricks your brain into believing that it is getting what it thinks it needs and it holds off withdrawal, while not allowing you to get high.  It gives you breathing room.  Some people/groups oppose the use of methadone because they believe that you are “substituting one drug for another”.  To a degree, this is true but if it allows someone struggling with addiction who could not have handled it otherwise to ease into recovery, maybe it is not a bad option.

Buprenorphine (Suboxone)

Suboxone is a new and improved methadone-type treatment. Suboxone is a partial opioid agonist, which means that it attaches to an opiate receptor and provides some opiate-like feelings, but it has other features that reduce the opioid-like response.  Buprenorphine (Suboxone) functions similarly to methadone except buprenorphine has a ceiling effect, that is, it reaches a level at which increasing the dose does not increase the effect.  This makes buprenorphine difficult to abuse and so it does not require daily distribution.

Suboxone also contains naloxone (Narcan) which is added to prevent abuse by injecting.  Under proper use, the naloxone is not well absorbed so it has no effect, but if it is misused by injection, the naloxone dominates, and the user is immediately thrown into withdrawal.  Obviously, not the desired result.

Naltrexone

Naltrexone, like Narcan, is a competitive antagonist for opiates, so it functions very differently from methadone and buprenorphine. This means that naltrexone pushes the opioid molecule off of the receptor and the naltrexone then occupies the receptor, keeping the opioid molecule from reattaching.  Naltrexone does not provide the opiate response in the brain, rather it prevents the euphoria and sedative effects of opioids, so abusing opioids while on naltrexone has no effect.  The person with substance use disorder is not tempted to use because it has no effect and if they relapse, the naltrexone prevents the feelings of euphoria.  Naltrexone not only works for opioids but it has a similar effect for alcohol, it blocks the euphoric feelings and feeling of intoxication associated with alcohol abuse.

Vivitrol

Vivitrol is a long acting, injectable form of naltrexone.  In order to combat the need to take a pill daily and the likelihood that someone battling addiction might fail to take the pill, Vivitrol was developed.  Vivitrol is a monthly injection that cannot be started until the individual has refrained from using for at least a week.  It is naltrexone, so it does the same thing, that is, block the euphoric and sedative effects of opioids and the euphoric and intoxicated feelings of alcohol.

Disulfiram

Disulfiram is used to treat chronic alcohol abuse and it cannot be used before detoxification is complete.  Disulfiram works by causing very unpleasant side effects if an individual drinks alcohol while on disulfiram.  It can cause nausea, headache, vomiting, and difficulty breathing shortly after consuming even a small amount of alcohol. And this can last for an hour or more.  Remember your first hangover when you swore you would never drink again?  Imagine that occurring as soon as you took your first drink, that would be quite effective at keeping you sober, if you continue to take it.

Acamprosate (Campral)

Acamprosate is used to treat chronic alcohol abuse, frequently in combination with naltrexone or disulfiram.  Like other addictive substances, chronic alcohol abuse results in changes to the brain that that cause extreme responses when alcohol is no longer consumed (withdrawal).  While the mechanism is not well understood, we know that acamprosate helps to stabilize the brain and reduce the impacts of withdrawal.

MAT is Not Perfect

You probably noticed that the drugs that I discussed above are used for opioid addiction and/or alcoholism.  There are currently no FDA-approved medications to treat other types of addiction such as, methamphetamines, marijuana, or cocaine.  Even for the substances that MAT is designed to address there are issues:

• For the medication to be effective, it must be taken regularly. Individuals may forget to take their medicine or may intentionally not take it.
• When we discussed suboxone treatment with our son, he pointed out that people who are not strongly invested in getting and staying sober will frequently turn to another (non-opioid) drug to get high when the cravings get too much for them to handle.
• An integral component of MAT, noted above, is support such as 12-step programs, counselling and cognitive behavioral therapy. The drugs by themselves will not cure addiction because we have not yet found a drug that can undo the changes that the brain has gone through as a result of addiction.

My Personal Bottomline

Would my son still be here if we had gotten him into an MAT program?  We will never know.  The drug doesn’t stop your addiction, it just gives you breathing room, it is your desire and the support of others that gets you to lasting recovery.  Is it wrong to replace a drug with a less dangerous drug?  I think that the answer is no if that is the only way to keep that person alive until they can manage lasting recovery.  You cannot succeed in recovery if you are dead.

Many people have very strong opinions regarding MAT and some even have experience with it.  Please share your thoughts or experiences.  We learn best when we learn from each other.

“In 2017 alone, 168 people died of drug overdose in Lancaster County, Pennsylvania, 167 of them were not my 22-year old son. I need know no other statistic.” – Doug Cwienk

In January 2017, our son was lying on the floor in our family room, literally dying. He was saved by the quick work of Bart Township Fire Company QRS and three shots of Narcan (generic name; Naloxone). Those two things gave us another 6 months with the terrific young man that our son was when he was attending his meetings and doing his step work. Narcan is very effective at saving lives but it is only useful for opioid overdoses (Nate had snorted heroin that evening), not other drugs. The effectiveness of Narcan is the reason that the Commonwealth of Pennsylvania has established a “standing prescription” so that anyone in Pennsylvania can go into a pharmacy and purchase Narcan without a prescription. I would like to dig into a little deeper discussion of Narcan and medication-assisted treatment (MAT) used to combat substance use disorders. So, please join me in this post, “Narcan and Friends”.

Note: I will use the term opioid throughout this post because it is a more general term. Opiates are derived from opium, ultimately from poppy plants. Opioids includes opiates, synthetic compounds that were developed to function like opiates and mixtures of the two.

How Does Narcan Work?

We discussed in earlier posts that opioid misuse causes a massive flood of dopamine in the brain. For this dopamine production to occur, the opioid molecule must first bind to an opiate receptor which causes other responses such as a pain relieving and sedative effect (that is what opioids were developed for). When you overdose on an opioid, you have too much sedative effect causing you lose consciousness and your respiration to be suppressed or stopped entirely. That is how an opioid overdose kills you, it slowly shuts your breathing down and then your heart stops because it is not getting the oxygen that it needs.

In pharmaceutical terms, Narcan is a competitive antagonist for opioids. This means that Narcan pushes the opioid molecule off of the receptor and the Narcan then occupies the receptor, keeping the opioid molecule from reattaching. What this means in practical terms is that a person in opioid overdose, given Narcan is taken from their extreme high to withdrawal very quickly because the receptors no longer have opioids attached to them. Knowing that withdrawal is extremely uncomfortable, the instantaneous ride from high to withdrawal must be horrible…but the alternative (death) is much worse.

Obviously, we do not want the Narcan to stay on the receptors forever because these receptors serve other functions, such as your brain’s own pain regulation systems. Narcan is designed to be metabolized in less than an hour, so that it is no longer in your body. Unfortunately, this means that if you overdosed with enough opioids, some are still running around in your brain. When the Narcan is broken down by your body the opioids that are still running around in your brain reattach to the receptors. This is very dangerous because it can cause an individual to go back into overdose. That is the reason why someone revived with Narcan needs to go to the hospital for a few hours of monitoring and re-administration of Narcan if necessary.

The Effectiveness of Narcan

Narcan is well designed for its intended purpose and it does its job very well. Some of the stronger opioid compounds, such as fentanyl and carfentanil are resistant to Narcan requiring more Narcan to reverse the overdose. I recently read a statement by the Lancaster County district attorney stating that we are on track to have fewer overdose deaths in the county in 2018 then we had in 2017. More people surviving is obviously good but it doesn’t mean that the opioid crisis is now shrinking. In fact, there have been more overdoses in 2018 than 2017 but more people are being saved by Narcan.
Narcan cannot be abused, it blocks the high of opioids. So, if you have a loved one that may be abusing opioids or you spend time around people that may be using opioids it would be wise for you to get Narcan and keep it with you. As stated above, if you live in Pennsylvania you can get Narcan without a prescription.

The fastest way to get Narcan to work is by intravenous injection, which is what the EMTs will do if they are saving someone. For regular people like you and me, the Narcan that we can obtain is a nasal spray. It is easy to administer and there are many places that will give you training in how to administer Narcan if you wish. In the Lancaster area, one group that provides this training is Project Lazarus. You can find a group in your area by searching on the internet for “overdose reversal training”.

What Narcan Does Not Do

Narcan does not let you down easy, it saves your life. By very rapidly stopping the effect of the opioid, it stops the suppression of your respiration but it throws you into withdrawal. As stated in the “Warm Hand-Offs” post the person revived with Narcan is often very agitated and cannot focus because their brain is screaming for the substance that it “knows” they need to survive. Their brain is trying to save their life using every trick that it can but it is wrong about what is needed. For more discussion of this, please refer back to the science of addiction posts that started this blog.

Narcan does not prevent relapse, in fact, many individuals have been revived more than once. How can you return to the substance that just tried to kill you? This makes no sense to a person that is not suffering from addiction. But, let me offer this analogy:

Suppose you are lost in the desert for a week or more and you are literally dying of thirst. You find a small pool of water and drink from it. The water is not pure. You become very sick and almost die. You survive and continue on but you are still close to death from lack of water. If you find another pool of water, would you drink from it, not knowing if it is pure or not? Of course, you would, you will die without water.

This is how a person with substance use disorder’s mind is working but it mistakenly thinks that the drug of choice is as necessary for survival as food or water. They will use again if they do not get and stay in recovery. They may even use in secret to hide that they have relapsed. That is what happened with Nate. He used in secret so that no one would know he had relapsed and he died alone, without anyone there to give him Narcan.
Narcan does not help a person with substance use disorder get or stay in recovery, that can be done with medically-assisted treatment which we will discuss in the follow-up post to this post. Do you have thoughts or experiences to share? Please comment, let’s work together.

NOTE: I have given more thought to using the term “person with substance use disorder” or “person suffering from addiction” rather than addict. It occurred to me that what is missing with the word addict is the word person. The term addict de-humanizes. It is like the use of Jap for Japanese people during WW2 or Huns for German people during WW1 or savages for native persons. It is easier to mistreat people, to look down on people, to allow people to suffer if we stop thinking of them as people.

I hope that you will join me next week for a discussion of “Narcan and Friends – Part 2”.

“Never forget where you have been.  Never lose sight of where you are going and never take for granted the people who travel the journey with you.”

There is a brilliant technique designed to get people with substance use disorders into recovery, called a “warm hand-off” that I want to share with everyone. Understanding this information helps everyone understand behavior associated with addiction, recovery, and the steps we need to take as a society to combat this horrible disease.  So, please join me in this post, “Warm Handoffs – A Brilliant Idea”.

What is a Warm Hand-off?

A warm hand-off is something that is set into motion by a person arriving at a hospital either because they overdosed, or they were injured in some other way due to their addiction.  Hospitals involved in this program then contact an individual in recovery who comes to talk to that person in order to help them see their need for rehab and to help them find a facility that will take them.  I had heard about this a few years ago, but this was the limit of my understanding.  The idea of having someone with intimate knowledge about addiction (someone in recovery) talk to a person in crisis (immediately after an overdose or serious injury) sounded like a great idea to me.  I knew that there was more to learn but I did not know who to contact.  I found out from a newspaper article a few weeks ago that The RASE Project was active in warm hand-offs in the Lancaster, Pennsylvania area, so I contacted them.

The RASE Project

I called The RASE Project, which is headquartered in Harrisburg, PA and was told that I should speak with Sandy Fisher, the Recovery Specialist Programs Supervisor.  I called Sandy and we had a great telephone conversation that taught me much more about warm hand-offs.  For starters, warm hand-offs are part of a program that is sponsored by the Commonwealth of Pennsylvania.  Pennsylvania requires that within each county in Pennsylvania, there must be an organization that is funded to provide warm hand-offs in that county.  The RASE Project is that organization for Lancaster County.

All of the major hospitals in Lancaster County participate in this program and they call the RASE Project anytime, night or day, that someone comes into the hospital having overdosed or otherwise seriously injured themselves as a result of addiction.  The RASE Project has five people in recovery that are tasked with providing support in the form of a warm hand-off.  Each person takes a turn on call 24/7 for a week at a time to answer the call from the hospital.  Each of the “Recovery Specialist to Warm Hand-Off for Overdose Survivors Program” members is a Pennsylvania CRS (Certified Recovery Specialist).  To become a CRS, an individual must be in recovery, must take many hours of classroom instruction and must pass a test.  Each of these individuals also works as a recovery center monitor, as well.

The individual on call talks to the person in crisis and attempts to get them to agree to go to rehab.  In the best case, this help is desired and The RASE Project staff will attempt to get them in a rehab facility as quickly as possible.  In the worst case, the person refuses to speak with the RASE Project staff member, in which case they are left with a packet of information in hopes that they may change their mind.  Sometimes, an individual is initially resistant to help but they come to the RASE Project facility a few days later seeking help.  The Lancaster facility also provides recovery coaching, recovery support groups, Buprenorphine (Suboxone) Care Coordination, and all day drop-in services.

Up until a few months ago, warm hand-offs were only for those revived from an overdose.  Like any good program, a need was identified to provide this service to anyone seriously injured by their addiction and it now helps them, as well.  I asked about our son’s survival of an overdose and if no one came because they saw that he had our support and was agreeing to go to rehab.  Sandy said that was probably the case but that they are not called 100% of the time.  The good news is that they estimate that they get the call from the hospital about 80% of the time and that number is improving as word gets out.

What is it like to Provide Warm Hand-offs?

Sandy suggested that I should stop by the RASE Project facility at 121 East Orange Street and speak with someone who goes to the hospital and provides a warm-handoff.  I met Brandon Hildebrand and he agreed to speak with me about his role in warm hand-offs.  We had a wonderful conversation that started with the general information provided by Sandy but soon led to a more personal discussion.  The one thing that I wanted to ask Brandon was how difficult it was to go address someone who was in the same position that he had been in years before.  Was this a trigger that might make him want to use?

Just as a reminder, triggers are smells, sounds, places, things, and tastes that remind an person of the times when they used and cause them to want to use again.  Triggers are a “trick” that the addictive part of the brain uses to try to get an someone with a substance use disorder to seek out the substance that their brain thinks it needs to survive.  Triggers lessen with time in recovery, but they may never totally go away.

Brandon said that what he experiences sometimes is not so much a trigger but it can take him back to his using days and all of the pain that he caused people. That is why he works his 12-step program and contacts his sponsor and support group.  In his words, you must have a very strong program to do this work.  Let that sink in for a minute.  The people that provide warm hand-offs willingly go into an environment that will remind them of their past and challenge their recovery, so that they may help others in the same situation that they have worked to put behind them.  Past posts have explored things that make recovery such a tremendous challenge.  These people charge into the teeth of the dragon to help save their fellow man.  Can there be anything more noble?  But still people look down on or fear those in recovery.

Challenges to Warm Hand-offs

So why wouldn’t someone who just virtually died want to get help to get away from the thing that tried to kill them?  Part of the answer to that question is the twisted thinking in the brain of someone with a substance use disorder.  Even though the drug almost killed them, the part of their brain associated with addiction is convinced that the drug is necessary for survival.  So, they don’t want to go to rehab where they cannot get access to that drug.

There is another issue that causes challenges for those trying to help someone get into rehab.  The source of this problem is Narcan/naloxone which I hope to discuss in a little more detail in the next post.  Narcan is what saved the person overdosing but it does so by instantly taking them from high to withdrawal.  When the addicted brain is thrust into withdrawal, it responds by trying everything at its disposal to get the individual to use.

The result of the brain’s efforts is an intense desire/craving to use that is so powerful that it is difficult to focus on anything else.  This is the challenge for the person attempting to help them get into rehab.  Most don’t want that help and even if they are not strongly opposed to it, they have a hard time focusing to understand the help being offered.  Some medical facilities are offering a therapeutic drug such as Suboxone/buprenorphine as the individual is recovering from their overdose and this acts to damp down the cravings and help them focus.

Brandon noted that recently he has seen more people that are happy to see him and want his help than in the past.  He believes (and I think that he is correct) that this is occurring because of the prevalence of fentanyl in street level drugs.  Fentanyl is much more potent than heroin and a fentanyl overdose is resistant to Narcan.  While the availability of Narcan is decreasing overdose deaths, fentanyl is having the opposite affect and that is scaring some people.

I often speak of “drug brain” as if it is all consuming and always present but that is not entirely true.  Remember that I noted people with substance use disorder typically think they can stop when they are high and know that they can’t when they are withdrawing.  Brandon put this another way that I think is very telling.  He said, “I didn’t want to be sick. I wanted to stop but the drug always wins.”

Is it Worth it?

Warm hand-offs are a great idea to help get people into rehab and recovery and they do work.  Warm hand-offs may put those people in recovery that are trying to help at risk of relapse. And they don’t work as often as we would like due to the many obstacles such as:

• The altered part of the brain of someone with substance use disorder believing that their drug of choice is necessary for survival;
• The difficulty that the person has in focusing because their brain has just been thrown into withdrawal; and
• Difficulty getting a willing participant into a suitable rehab facility quickly.

Despite the hard work, risks and difficulties in making warm hand-offs work, I absolutely think that they are worth the time and money.  The concept is excellent and perhaps we will find ways to reduce the obstacles, such as the use of therapeutic drugs to reduce the effects of withdrawal.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

NOTE:  You may have noticed that I stopped using the term addict in this post and I replaced it with “person with substance use disorder”.  I initially did so at Sandy’s suggestion that there is a great deal of stigma associated with the word addict.  I understood Sandy’s point but I feel disingenuous when I use what I perceive to be euphemisms.  I am currently taking the coursework to become a Certified Family Recovery Specialist in Pennsylvania and this same thing came up in that class.  I expressed my reluctance there and the instructor made a very good point.  First and foremost, when we are trying to help people we must be sure that we do no harm.  If the term addict has a strong stigma such that it may be hurtful or may cause the people that we are trying to educate to hold onto their misconceptions and stigmas then we should not use it.  From now on in this blog, I will only use the term addict when I think that it is necessary for the point that I am making.

I hope that you will join me next week for a discussion of “Naloxone (Narcan)”.

“Almost everything you think you know about addiction is wrong.” – Johann Hari

After my last post about stigmas, it was suggested to me that I should listen to an NPR TED Radio Hour podcast entitled “Confronting Stigmas”. The episode was excellent and addressed several areas of stigmas starting with an interviewee named Johann Hari, who discussed the stigma of addiction. When Mr. Hari spoke of the stigmas and how they get in the way of addressing our drug crisis he said many of the things that I said in the last post. In short, addicts need to be embraced, accepted, and helped, not rejected, shamed, and humiliated. I whole-heartedly agree.

Much of Mr. Hari’s interview revolved around his TED Talk entitled, “Everything You Think You Know About Addiction is Wrong”. I was curious about what he was saying and did this mean that I had this whole addiction thing wrong. I must admit that I have my biases based on the research from the NIDA/NIH; my own experiences; my desire to believe that I was a good parent; and let’s face it I’d hate to be wrong, especially a dozen posts into my blog.

I did my best to be objective and I watched his TED talk. The things that Mr. Hari said have changed my view, slightly, but I believe that he does not fully understand addiction and consequently his interpretations are not completely accurate. I believe that almost everything we know about addiction, based on hard science is correct. Please join me in this post, “Counterpoint” as I explain Mr. Hari’s information and conclusions and how I would reinterpret his observations.

Johann Hari and Addiction

Mr. Hari did a great deal of research for a book he wrote that largely centers around how we pursue the war on drugs and the failures in our approach. I am reading this book and I must admit his storyline seems awfully neat and clean for the real world, but I am not about to re-do his research, so I’ll accept his story. I mention this book because I believe that in doing that research he came to the conclusions that he presented in the TED talk. Mr. Hari has a few main premises that he presented including:
• Trying to stop the flow of illicit drugs does not work and in fact, makes the drug traffickers richer, more powerful, and more violent.
• Stigmatizing and disconnecting addicts from society, starting with the legal systems currently in place and including attitudes of the public and potential employers make huge obstacles that addicts must overcome. Removing these obstacles would reduce the addiction crisis.
• Decriminalizing all drugs and providing clean and safe facilities in which to use would save lives, bring order, reduce stigmas, and reduce crime and violence.
• The concept that drugs have “chemical hooks” that get a hold of you is incorrect. People use because they are unfulfilled, unhappy, or in pain. He is in effect saying that there is no addiction as I have described it.

The War on Drugs

By Mr. Hari’s estimation, we have been fighting the war on drugs for one-hundred years and we are currently failing spectacularly. I am less critical of the war on drugs than Mr. Hari because I believe that it has been pursued with the best of intentions and I find it hard to embrace most of the alternatives. We cannot, however, argue that the war has been a success given the length of time it has been going on and our current situation. Mr. Hari makes an interesting statement that I think speaks volumes about how the legal system’s approach does not work for drugs the way it does for crime in general. He said that when you arrest a lot of rapists, you get less rapes and less violence. When you arrest a lot of illicit drug suppliers you still have the same quantity of drugs and you have more violence because there are turf wars over who will get that piece of the market.

One of the things that I like to point out in most discussions in which someone is insisting that “we have to do something about (fill in the blank) now” is the very real possibility of unintended consequences. There are two very clear examples of unintended consequences from the war on drugs. In addressing the recent opiate crisis, we greatly restricted the access to legally prescribed, opiate painkillers. The unintended consequence is that we have more heroin users and there was an expansion of the fentanyl supply as prescription painkillers became expensive and difficult to obtain. In the 80s and 90s we established mandatory minimum sentencing for drug traffickers. The unintended consequence was that our jails got overcrowded and we were forced at times to release violent criminals from prison because mandatory sentencing stopped us from releasing non-violent drug offenders.

I agree that the war on drugs has frequently had the opposite result to the one intended. Unfortunately, I think that drug addiction is too great an issue to just allow the illegal trafficking of drugs to happen.

Decriminalizing Drugs and Clean Needles

Mr. Hari’s solution with regard to the failure of the war on drugs is to do the opposite of the current system that is not working. That is, we should decriminalize drug use, all drug use from pot to crack cocaine to heroin. This will remove the stigma from addiction and permit addicts to become reconnected to society. He cites two examples of countries in which this method worked, Portugal and Switzerland. Mr. Hari has concluded that addicts use because they are unfulfilled with their life, their life lacks meaning, and they are disconnected from society.

If you go back to “Part V – Nature and Nurture Decide” and look at the risk factors identified by NIDA/NIH you will see that they concluded that the same sorts of influences can increase an individual’s likelihood of becoming an addict. The very important distinction here is that Mr. Hari concludes that this is why people use and if you eliminate this, people will stop using. NIDA/NIH says this may help to lead you down the path of addiction. If you conclude as Mr. Hari did then there is no addiction as we know it. I cannot agree with that.

Portugal

In the 1990s, Portugal had a massive cocaine and heroin problem. Estimates are that up to one percent of the population was using drugs. In 2001, Portugal decided to reverse course and adopt a new way of addressing this problem. The use of all drugs was legalized. Needle exchange programs were instituted. Methadone clinics were mobilized in vans to make it easier for addicts to get that help. Programs were started to attempt to get addicts employment and get them contributing to society. Skeptics said that this would cause an increase in drug use as drugs became more available and accepted.

In 15 years, drug use fell by roughly 50%, overdose deaths fell, and the incidence rate of diseases such as HIV and hepatis dropped dramatically. By most metrics, the policy in Portugal is working far better than our own policies. Mr. Hari concluded that this outcome was the result of a reduction in the stigma of addiction and that this supports his belief that drug use is a response to trauma or lack of self-fulfillment.

Switzerland

Like Portugal, Switzerland had a massive drug problem. The Swiss took their efforts even further than Portugal. In Switzerland, there are clinics where you can take your heroin, turn in your used needle, and a health care professional will give you a new needle and monitor you as you shoot up to make sure that you do not die from an overdose. Obviously, this saves lives and presumably it reduces some of the stigma, but how much? If Mr. Hari’s conclusion that addiction does not exist, rather it is an expression of unfulfillment, then this technique may be reasonable way to keep people alive until they can find satisfaction in their life.

Drug/Addiction’s Hooks and the Vietnam War

Mr. Hari stated the idea that drugs have “chemical hooks” and grab ahold of your brain is wrong. He says that the idea that if you gave a group of people heroin for several weeks they would all be addicts is wrong. Mr. Hari’s concept of addiction as the result of chemical hooks that will grab anyone is outdated. He is interpreting the information he gathered with an outdated model of addiction, seeing that it doesn’t fit and concluding that everything that we think we know is wrong.

Let’s look at Mr. Hari’s argument based on the Vietnam War. Approximately 10% to 20% of American servicemen in the war were heavily using hard drugs. There was a real fear that when they returned home there would be a massive epidemic of drug abuse. There was not. According to Mr. Hari this supports the idea that they were unfulfilled, unhappy, and traumatized. When these issues were gone, they didn’t use. Well, that isn’t quite true. Many servicemen did stop using but many continued, in fact, the rate of relapse/continuing addiction seemed to match drug use in the general population. (Robins, Lee N., (1993) “Vietnam Veteran’s Rapid Recovery from “Heroin Addiction: A Fluke or Normal Expectation?”, Addiction Vol. 88 pp. 1041 – 1054)

Furthermore, does anyone think that when our guys got home from Vietnam and were despised by many Americans that opposed the war, that their lives were suddenly fulfilled, that the trauma suddenly disappeared? Only someone born several years after our guys returned from Vietnam and raised and educated outside of the USA could believe that things suddenly got better for those who fought a horrendous war without much support from home.

What Do I Think About Mr. Hari’s Ideas About Addiction?

I very seriously considered Mr. Hari’s conclusions and examples because I didn’t want to be wrong but more importantly, I don’t want to spread incorrect information. I believe that Mr. Hari’s interpretations are hamstrung by his lack of understanding of the current science and model of addiction.

I did consider that my own position with regard to addiction might need a little fine tuning. So, let’s fix me first. I have stated that heredity decides if you will become an addict, once you have decided to use and that we each have a different tendency toward addiction. I don’t want to say this within earshot of an adolescent brain but there appears to be a significant portion of the population that can use and not become addicts. I acknowledged this in prior posts, but I now believe that we are really looking at about 10 to 20 percent of the population that will become addicts if they use regularly. To an adolescent brain those may be good odds but the cost of being on the short end is huge.

My simplified path to addiction goes like this; you try it, you like it/want it, then you need it and that is when you become an addict. Apparently, only about 10% to 20% of the population make that last step which physically alters the brain into believing they need it and being an addict. In the past, we believed that if an individual stopped using and had symptoms of physical withdrawal, this indicated addiction. We now know that withdrawal symptoms are a physical response that all users will experience, while addiction is physical and psychological alteration of the brain that is not experienced by everyone.

In all of Mr. Hari’s examples, I believe those individuals using to feel better but who have not turned the corner to needing/to addiction are responsible for the improvements in the rate of addiction. So, those individuals get better, but we are still left with the true addicts. It happened when our guys came home from Vietnam and it is happening in Portugal. If I am right the reduction in addiction in Switzerland and Portugal will plateau, there will be little additional reduction. This is because we significantly reduced the number of people using to self-medicate that are not true addicts. The brains of real addicts have been altered, conditioned, physically changed to support addictive behavior. The addicts need much more help to undo the damage that has been done to their brain by addiction. This is not a conclusion that I pulled from some anecdotes or examples, this is supported by extensive research including brain scans.

Mr. Hari says that drugs don’t have chemical hooks that latch onto your brain, everyone’s brain. He is right, we haven’t believed that for some time now. Your brain physically changes itself in response to the drug’s impacts on the brain, such as, the massive dopamine surge, conditioning, neuroplasticity, etc. So, some individuals have brains that respond to the drug in a way that physically alters their brain but not everyone.

Let’s Get Personal

As I said, I tried to remain objective, but I do have my own experiences to add to this discussion. I believe that the path to drug addiction often starts from pain, trauma, isolation or simply living a life that is not meaningful. I do not believe the addiction itself is that simple. I believe that my son started using because of his own feelings about himself but I saw the dark side of his addiction. I saw the person that did not have the honesty, integrity, or compassion that my son originally had. I also saw those characteristics come back through the long, slow process of recovery. I saw him become very fulfilled. I saw him become very compassionate. I saw a desire to learn that had not been there for a long time. And I saw a very deep, profound connection to the sober community. By Mr. Hari’s model, that would have been the end of it..he was cured (by the way, that’s an AA joke/sarcasm, you’re never cured). Nate relapsed because it takes a long time for an addict to undo most of the changes that have occurred in their brain. He was not simply someone using to damp down some pain or trauma, he was an addict and he died because of it.

My Conclusions

Mr. Hari’s work does some wonderful things, but it also does a great disservice to true addicts, their families and most importantly to the education of the public that we need to solve this problem. When he speaks of stigma, he is right on the mark. When he causes us to rethink our approach to drug addiction, he broadens our vision and perhaps we will see the answer. BUT when he implies that there is no such thing as addiction he is not only wrong he does great harm to our attempts to help addicts. And speaking of stigmas, he is in effect saying that we raised a son so unhappy with his life and himself that he used until he died. He needs to talk to me, I saw something way different. My examples are just as meaningful as his and there is hard science to support the idea that addiction is a physical and psychological disease of the brain.

Do you have thoughts or experiences regarding this post? Do you want to tell me why I am wrong or what else I should read? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in two weeks. I may actually get back to more misconceptions and stupid brain tricks, or maybe something better like this will come along.

“Don’t judge me by my past, I don’t live there anymore.” – Anonymous

About two months ago, my post was titled “Misconceptions and Stigmas Part I” but I got too wrapped up in the misconceptions and didn’t write about stigmas.  There is more to say about misconceptions in the future but today’s post I want to focus on the stigma of addiction and its impact.  To a large degree, the stigma of addiction is derived from misconceptions.  It is my goal in writing this blog that we may educate people and bring down some of the barriers to successful recovery, so please join me in a discussion of “Stigma of Addiction and the Damage Done”.

The Stigma of Addiction

As I have written scientific reports for years, I have this compulsion to define my topic.  So, what am I referring to in this post as the stigma of addiction. In this post, we will consider the stigma to be a very negative stereotype from which people make judgements and take actions.  If you were to treat someone based on their race, religion, or sex the way many people treat addicts, you would be branded a racist, sexist, or worse.  Some of the behavior that we see toward addicts as a result of this stigma include:

• Avoiding addicts and their loved ones, as if addiction is contagious.
• Refusing to ever trust addicts in recovery because of “past sins”.
• Refusing to provide help to addicts because “they do this to themselves”.
• Looking down on addicts and their families because “there must be something wrong with them that this happened”.

The Addict

Obviously, the most profound impact of the negative stigma of addiction is felt by those most vulnerable to the damage it can do, the addicts. I shouldn’t need to say this but just to make sure it is clear to everyone, ADDICTION IS NOT CONTAGIOUS.  Your family will not catch addiction from contact with an addict.  Obviously, we want to protect our kids and keep them from hanging out with individuals that are “trouble”. But if your son or daughter goes to school, they have already been in contact with those individuals for a long time.  In my opinion, you will not keep your loved-ones safe from addiction by shielding them from unsavory-types.  You will protect them by educating them.  As I said before, I don’t think that there are many people pushing drugs anymore but there are plenty of people supplying drugs if you want them.

Treating an addict like he/she has leprosy does not protect anyone, but it does harm the addict.  Drugs such as opiates are largely used in isolation.  In discussing when and how he used, our son told me that he didn’t want his friends around when he used because “They get in the way of the high.”  I believe that many addicts, my son included, started using because of low self-esteem and discomfort in social situations.  Isolating these addicts just drives them further into their addiction.

SIDE NOTE: To my son’s friends, this does not apply to you, you were awesome friends.  To Ingham’s Powder Coating in Denver, Pennsylvania none of this applies to you.  You showed Nate that you trusted and valued him and that helped him more than I can express.

Not trusting addicts because of things that they did in the dark depths of their addiction may be just self-preservation, so isn’t that okay?  I understand self-preservation and I don’t blame people for caution, but I do believe in a thing called FORGIVENESS.  Things that addicts do when their brain is being twisted by active addiction can be bad.  My son would say “We lie, we steal, that’s what we do when we are using”.  But a large part of the 12-steps of AA involve acknowledging what you did, forgiving yourself, and making amends.  That is a huge challenge, especially the forgiving yourself part, made that much harder when they feel that no one trusts them. Last week, someone ran into my car in the parking lot.  He came to get me, owned up to his mistake and has arranged to get my car fixed.  Should I hold a grudge against him because he wasn’t more careful?  That would be ridicules, so let’s cut a break to those that were in a terrible place and are trying to get better/be better.

I have already hammered on those that would look down on addicts and refuse them reasonable help in past posts.  If you don’t see what is wrong with treating addicts that way, go back to the earliest posts and start reading.  Actually, if you don’t see what is wrong, then you probably stopped reading long ago.  One thing to note is that I used the term “reasonable help”.  Some of the most difficult decisions that we had to make were framed by the question, “are we helping our son or are we aiding/facilitating his addiction?”  I frequently won’t give money to a homeless person if I suspect that they are an addict because I fear that I may be continuing their addiction when they need to be forced into seeking help.  How we treat people need not be all or nothing.  Please educate yourself about addiction before it directly impacts you and let’s work to bring this crisis to an end.

The Family

When we found out that our son was an addict, we had some very difficult choices to make that were piled on top of the nearly impossible decisions that we had to make daily regarding his addiction.  We decided that the best course of action was to keep his addiction to ourselves.  This decision was driven by our fear of the stigma that would be placed on our family, our house, and our addicted son.  We feared the judgement that “they must not be the good family that they seem to be because their son is a drug addict”.  We live in a small town/rural area and rumors can run wild.  Who knows what explanations might get passed around to explain what happened.

I believe that one reason that people don’t learn about addiction is that it is more comfortable to believe that your family is safe because you are good people and have strong character.  Those thoughts reduce your anxiety, but they may make you judgmental and they get in the way of solving the problem.

We feared the way that people would treat us, knowing that we had raised an addict.  To this day, people still avoid us sometimes and it is difficult to tell if they are judging us or just don’t know what to say.  Let me clue you in, talk to us.  Talk about Nate, talk about something else but talk to us.  You won’t catch what we have, and it hurts to feel alone.  Give my wife a hug if you feel close enough, she needs it.

We also decided to keep quiet about Nate’s addiction so as not to hinder him in the future.  Like every family, we clung to the hope that someday, preferably soon, his recovery would be strong enough to stop him from ever relapsing again.  We did not want him to have his future opportunities hindered by a statement like “are you sure you want to hire him, you know he is an addict, right?”

Isolation is difficult and painful, whether you imposed it on yourself because you thought it was what was best at the time or because people are judging or fear you.  I don’t think that I can say this too much, get educated about addiction so that you are not uncomfortable around those impacted by addiction and they don’t feel like they have to hide in the shadows.

The Impact

The Addict and Society

Why should you care about tearing down the stigma of addiction if you are not impacted, don’t know me or anyone like me?  The simple answer is that we are all impacted, this is a societal issue in addition to an individual issue.  Likewise, I live in rural Pennsylvania, in my township over 95% of the residents are of European/white decent.  Does this mean that I don’t need to be concerned with racism, that it does not impact me?  Hardly.

Addiction is killing people, destroying people, destroying families, destroying the very fabric of our society.  When you judge or isolate addicts, you make their recovery so much more difficult.  Alcoholics Anonymous is anonymous for a very good reason, they frequently are not accepted by people despite the arduous journey that they are taking.  I look forward to the day when the anonymity is solely that you don’t have the right to reveal another’s struggles not that you fear judgment of your own.  Staying in recovery and managing your addiction is a nearly impossible challenge, must we make it even more difficult?  Are addicts not people just like you and I?  I have my faults just as you do.  We are just lucky that we were blessed to not be burdened with a mind inclined toward addiction.

Another impact of stigmatizing addiction is that it makes many addicts reluctant to seek help.  Getting an addict into recovery can be very difficult, made all the more difficult by the fear that “everyone will know” when I disappear for 30 days.  How do I explain the gap in my employment history when I try to get a job again after time in rehab and recovery?  These are just more obstacles thrown in the path of recovery.

The Family

Families of addicts need support and need to not feel judged for their loved-one’s affliction.  I still think that we made the right decision by sharing our journey with Nate’s addiction with very few people at the time.  I think that our fears of what people would think and say were valid.  But the isolation was very difficult.  Most families either become closer or fall apart.  We became closer.  The community of friends that help us now that Nate is gone, and we can speak out is a tremendous help.  I wish that we could have reached out to these people while we were struggling with his addiction..before we began struggling with his loss.  This is not a comment on our friends, I know that they would not have judged us.  It is society as a whole that drove us into isolation and that needs to change.

Fear of being judged for your loved-one’s addiction keeps people from sharing and that keeps people from learning.  We are free to talk to you about our journey now, the worst has already happened to us.  Most people do not see addiction that is all around them.  Many people judge all addicts based upon the addicts that they see on the street.  If people understood the how’s and whys of addiction they would be less inclined to judge any addicts.  They would be more inclined to help and perhaps less help would be needed if fewer obstacles were placed in front of recovering addicts.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in two weeks.  I may actually get back to more misconceptions and stupid brain tricks, or maybe something better will come along.

“It is often in the darkest skies that we see the brightest stars.”  ~ Richard Evans

I intended to write about misconceptions again on today’s post but a reader, that I now consider a friend, suggested that I do a post on spirituality and recovery. I do not have personal experience and I suggested a guest post or collaboration. What I received was a complete post that is an excellent read, provides meaningful insight, and it is profoundly moving. Everyone’s story of recovery is unique, yet many will relate to this story as I think that spirituality is critical in the lives of most people that remain in recovery. Here is Augustus Feleccia’s experience in his own words.

I remember the exact date of the day that I was cured of my obsession to use drugs and alcohol. On January 11th, I was changed from the inside out. After being helplessly addicted for 6 years, I was desperate. My relationship with my family was falling apart and was extremely strenuous. I was depressed and would sometimes not leave my room for days. I had had my right arm taken from me when it became paralyzed in a college football drill that knocked the nerves from my spinal cord. With this came hundreds of doctor’s visits that led me to an abundance of prescription medication. I was ashamed and regretful of my past, I was fearful and hopeless about my future, and my present was filled with doing whatever would make me feel momentarily better despite who it hurt. Like a rat, I had been digging a hole for myself through drug use that seemed insurmountable. Every night I would go to bed high and be determined to quit. In the morning I was in withdrawal and that promise was out the window.

When my best friend visited from North Carolina, he was a different person than from when I had last seen him. He was filled with joy and love and would not stop talking about the Bible. I became frustrated by it by the end of his visit, telling him “you don’t need to shove it down my throat. I’m glad it helps you, but it just isn’t for me.” Years later, Sean would tell me that he knew I would say that, but he was trying to help me. The idea of Jesus dying on the cross for my sins always confused me, but when I reached my point of lowest desperation, Sean’s words stuck with me. “Without God we cannot do much. But with Him, we can do anything.” This helped me immensely in not using for a few days, but it would always come back when I forgot about God. The logical, rational brain was doing just enough to get me by. I finally discovered that there was something greater than just that on January 11th, 2015. Beaten down and scared, I decided that I was desperate enough to beg God for help. I got on my knees in front of my crucifix and began to cry. I didn’t know what prayer to say, and finally I just blurted out “God, help me!” What happened next has been described by nearly every culture and religion. At once, I felt an intense feeling that something was with me. This being-if you like to call it that-loved me deeply. It accepted me for who I was and wanted the best for me. When I looked up at the cross, I saw Jesus’ arms extended on the crucifix, almost as if he were saying “come here and embrace me. You are with me now” I felt intense joy and knew that nothing would ever be the same. I then thought about how I had been living my life and felt so sorry for all of it. However, almost as soon as it came, it was gone as I finally understood the forgiveness of God. I knew intrinsically-almost as if you know you’re hungry-that my soul would live forever with God. I began living my life with a fresh pair of eyes, and the world looked and felt very different. I checked myself voluntarily into rehab shortly after and have not used since. The experience is still the single most important moment of my life.

This may sound like crazy pseudoscience nonsense to the more logical, 3-dimensional thinker, but experiences like this are a lot more common than you think. Bill Wilson had a very similar experience and thus created the 12 steps of Alcoholics Anonymous as a way of getting alcoholics (who just couldn’t warm up to the J or G words) to that same experience.

Here, we see how the 12 steps are directly from the framework of the Gospel.

1. We admitted we were powerless over alcohol—that our lives had become unmanageable. This is what I admitted, but to painkillers instead of alcohol. I admitted that I was “licked” and that I truly needed help. My prayer was literally just a sincere “God, help me!”. I “repented”, or changed my mind, to the way that I had been living my entire life thus far.
2. Came to believe that a Power greater than ourselves could restore us to sanity. This is where I had my white light moment. He showed Himself to me immediately after asking.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him. After having this experience, Jesus had entered my life and He would never leave. I would now live through and for Him.
4. Made a searching and fearless moral inventory of ourselves. I realized all of the wrongs that I had ever done-especially the ones that made me uncomfortable and I didn’t want to think about.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. God already knew all of these and forgave me. Admitting them was for my well being, not just His.
6. Were entirely ready to have God remove all these defects of character. I knew that He could. I knew that I was forgiven. At that point, I had no trouble at all talking about my wrongs in life to anyone. As I did, I was further freed from their emotional chains.
7. Humbly asked Him to remove our shortcomings. As I admitted them, God began to live through me and I lived out His will for me. My shortcomings were me acting selfishly, not through God.
8. Made a list of all persons we had harmed and became willing to make amends to them all. This was a natural response to my spiritual transformation.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others. Again, this became natural. I wanted the whole world to see God and this was how I showed that love.
10. Continued to take a personal inventory and when we were wrong promptly admitted it. Everyday was spent in prayer, attempting to do the right thing and asking for God’s guidance and forgiveness when I screwed up.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Being as though “conscious contact” with God was a better high than any drug, I tried for it every chance I could.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs. This is also what keeps us sober. Helping others and service is the main instruction in the Bible as well as in the rooms of AA.
So, what is going on in my brain, and why do we see this same experience helping so many of those in recovery?

Scientists at Yale University recently did a study* where they discovered that the part of the brain responsible for the awareness of ourselves and others lights up when going through a “spiritual experience.” What this explains is that during these moments, the brain starts to slowly not recognize itself as an individual separate from others, but rather a part of the larger whole. This concept is found in Christianity, Buddhism, Islam, Judaism, Hinduism and just about every other major religion of the world. The brain effectively becomes more selfless-exactly what AA teaches us to be.

These studies may be showing us that the way we think as a culture as well as individuals may be wrong. I personally find it odd that of all the science and medicine we have (which are both incredible and important) the most effective treatment we have for addictions of any kind lay in the stepwork filled with words like Higher power, prayer, and God’s Will. Could it be that maybe pure logical Science is not all of what it takes? Could it be that just maybe, there is more to the effectiveness of 12 step groups like Alcoholics Anonymous than just trading a drug addiction for a meeting addiction and white knuckling it through life? Can we be figuratively born again as new people with a new perspective on the world? Most importantly, can our world be reborn from one that uses a pill to fix everything to something more; something deeper? I believe that the answer is yes. With more studies coming out confirming this theory, it may be time that we start treating addiction completely different from the way we have been seeing it as a choice that needs punishing into a ‘spiritual malady’ that requires love. Whether you believe in religion or not, there is now evidence that it’s teaching have very real effects on those who practice them.

Augustus J.F. Feleccia is now two years sober and still doing well. He is eight years post-injury and has learned to get by without much use of his right arm. He works for a non-profit telling his story at schools and community centers in hopes that he can prevent any kid from becoming addicted to drugs. He also offers evidence-based prevention programs in Delaware County, PA.

You can reach him at afeleccia@childandfamilyfocus.org

* Lisa Miller, Iris M Balodis, Clayton H McClintock, Jiansong Xu, Cheryl M Lacadie, Rajita Sinha, Marc N Potenza; Neural Correlates of Personalized Spiritual Experiences, Cerebral Cortex, , bhy102, https://doi.org/10.1093/cercor/bhy102

“Angel of darkness is upon you, Stuck a needle in your arm, So take another toke, have a blow for your nose, One more drink, fool, will drown you.” – Lynyrd Skynyrd, That Smell

I am back to posting on schedule, but I am going to change the schedule to posting every other Monday morning.  I decided that this post will be about song lyrics that shed light on the dark side of addiction.  I wanted this to be a little lighter since my last post was pretty difficult for me to write.  If you look up songs about drug use, you will find many.  Some glorify drugs, some require a lot of interpretation and many if they don’t glorify drugs, they don’t add much to the conversation, such as Neil Young’s “The Needle and the Damage Done” or Lynyrd Skynyrd’s  “Needle and the Spoon”.  I have chosen two songs that I find very relatable and insightful.  Please join me in today’s topic “Song Lyrics – Insight into Addiction”.

She Talks to Angels

Even songs that do not glorify drug use tend to sound like drug use is pleasant or cool until you look deeper.  One such song that really covers many aspects of addiction is “She Talks to Angels” by The Black Crowes.  The song is about heroin use and the expression “talks to angels” sounds both fitting and pleasant.  Who wouldn’t want to talk to angels? But the expression is actually acknowledging that when high on heroin, you are very close to death, close enough to talk to the angels.  Unlike many songs about drug use, this song announces its subject from the start, “She never mentions the word addiction in certain company”.  You might also consider that this speaks to the stigma of addiction.  Let’s look at some other quotes:

“Yes, she’ll tell you she’s and orphan, after you meet her family” – This clearly speaks to the alienation that comes with ongoing drug abuse as your friends and family pull back to protect themselves.  Watching someone you love destroy themselves is exceedingly difficult, not to mention the unethical behavior that tends to accompany active addiction.  She has family, yet she is orphaned.

I remember when our son was in high school, he knew a young man in his grade that was heavily abusing drugs.  Our son was appalled that this young man’s parents chose to kick him out of their house when he was still in high school.  I explained that he had younger siblings and his parents probably figured that if he would not change, they should at least protect their younger children.  He understood somewhat but what we didn’t realize was that he was appalled/scared because he was headed down the same path.

“Oh yeah, there’s a smile when the pain comes. Pain’s gonna make everything alright, alright yeah ” – To those that are not familiar or are younger, this statement might sound cool at first, like you are tough if you use.  That is not what it is saying.  What this statement is pointing out is that the conditioning of addiction is so strong that the pain of the needle and the burn of the drug bring a smile because she is conditioned that the high comes next.  She is controlled by the drug (the addicted part of her brain) such that this particular pain is pleasant.

“And the cross from someone she has not met, well, not yet” – This statement is obviously saying that she has not met Jesus/God, yet.  This is open to some interpretation but my first thought is that she has not met Jesus/God yet because she has not died yet.  But she is close, “she talks to angels, says they all know her name”.  Another thought that occurred to me requires an even deeper understanding of addiction and recovery.  Most 12 step programs, AA being the model, stress spirituality and turning your life over to a higher power.  They refer to God as you perceive Him or as he reveals Himself to you. Perhaps the song is saying that she has not met Jesus/God because she has not seriously undertaken recovery.  For many addicts, they will meet God (as they perceive Him) either when they get serious about recovery or when they die.  Or in the case of our son, he did the first and the second happened anyway.

“She don’t know no lover, None that I ever seen. Yeah, to her that ain’t nothing but to me it means, means everything.” – This line chokes me up every time I hear it because it cuts so close.  This line is highlighting the fact that addiction alters your brain such that the most important thing in your life is getting your next fix.  “She don’t know no lover” because she has no room for anything but the drug and “to her that ain’t nothing” because her brain is so twisted that she sees nothing wrong with that.  To the singer, however, “it means everything” because he understands her empty life.  My son was an alcoholic by about the time he hit high school and was using heroin by the start of his senior year.  He never knew the joy of falling in love because his brain was preoccupied with his addictions.  As parents, the knowledge that our son died without ever experiencing falling in love causes us great pain.

Angel by Sarah McLachlan

Angel by Sarah McLachlan is a beautiful performed, wonderful song that the ASPCA is doing its best to ruin with their commercials.  I know she chose to allow it because she values their work, but must I hear it so often with pitiful scenes of neglected and abused animals.  Reminds me of the end of A Clockwork Orange, but I digress.  Even if you don’t know the underlying meaning of this song, it is very touching.  Sarah revealed in an interview that she wrote the song for or about the drummer from Smashing Pumpkins who died of a heroin overdose while on tour.  She said that she didn’t use drugs but could relate to the feeling of loneliness on the road, the pressures of the music business and the need for escape.

This song is not as quotable as She Talks to Angels, but it captures the mood and feelings of inadequacy that I suspect haunts many addicts.  The song sets this tone clearly from the start:

Spend all your time waiting
For that second chance
For a break that would make it okay

There’s always some reason
To feel not good enough
And it’s hard, at the end of the day

And continues later in the song with:

The storm keeps on twisting
Keep on building the lies
That you make up for all that you lack

Sarah’s incredible voice and the stripped-down performance, just piano, bass, and her voice, reinforces those feelings.  Lines like “Memories seep from my veins” give you some indication that this is about heroin.  To me, the underlying theme in the song that relates most to addicts is the need to escape the pain that drove them to use in the first place.

From about the time that I was in junior high, I always wished for serenity and I felt a very strong connection to the Serenity Prayer.  I learned from my son that the Serenity Prayer plays a big role in AA and recovery.  I think that this search for peace and serenity, by escaping the things that plague them, plays a big part in most addict’s lives.  The song hits on this thought many times with lines like:

“I need some distraction, Oh, beautiful release”;

“And the endlessness that you fear”;

“Escape one last time. It’s easier to believe in this sweet madness. Oh, this glorious sadness”

All of the feelings of inadequacy, emptiness and the need to escape them culminate in the end of the song with, “You’re in the arms of the angel, May you find some comfort here”.  Perhaps the comfort in the arms of the angels is like talking to angels in The Black Crowes’ song but given the motivation for the song, I suspect you are in the arms of the angels when you die.  I hope that Nate and all those that lost their battle with addiction find some comfort there.

I guess that I didn’t do a very good job of keeping this light.  Do you have thoughts, songs, or experiences to share? Please comment, let’s work together and help each other to understand this problem.

I hope that you will join me in 2 weeks for a discussion of “Misconceptions, Stigmas Part 2?”.