Sober Living by the Sea Blog

Men Are More Likely To Crave Alcohol When They Feel Negative Emotions

2008-05-12T10:15:00.000-07:00

This probably comes as no surprise, but men and women tend to react to stress differently. A study of emotional and alcohol-craving responses to stress has found that when men become upset, they are more likely to want alcohol than women. Women on the other hand, have greater rates of depression and some types of anxiety disorders than men.

This is the type of pattern that we have addressed at Sober Living by the sea by creating separate programs for men and women, and particularly find it helpful to create a gender specific environment during the first 30 or 60 days of primary treatment. Our Landing and Sunrise Ranch facilities for men provide structured, highly supervised support for males who are chemically dependent. Our Rose and Victorian House for the treatment of Eating Disorders able to create nurturing and supportive environments for females, allowing them to work on their women's issues with other women in recovery in a safe and intimate environment.

The recent study was authored by the Yale University School of Medicine and was conducted by exposing over 50 adults to role playing activities and closely monitoring their response. The role playing was conducted as "imagery scripts" which were divided into these categories: stressful, alcohol-related, and neutral/relaxing. All role playing was conducted in separate sessions, on separate days, and in random order. The results of the research concluded that women are more likely to feel sad or anxious after a stressful experience and men are more likely to drink alcohol as a result of a stressful experience.

Addiction - Is it a disease or a moral failing?

2008-05-07T12:29:00.000-07:00

I am going to re-post Dr. Kevin McCauley's reponse to a recent article on slate.com written by Sally Satel and Scott Lilienfeld claiming that Addiction is Not a Disease.

The most important question there is about addiction

A response by Dr. Kevin McCauley, M.D. to the article posted on Slate.com "Medical Misnomer: Addiction isn't a brain disease, Congress"

The question of whether or not addiction is really a disease is the most important question there is about addiction, and the reputation of addiction medicine rests upon its ability to provide a coherent answer. One of the major projects at our institute is to investigate the possibility of such an answer.

Her odd association with an ultra-conservative think thank (The American Enterprise Institute) notwithstanding, Dr. Satel’s monograph “Is Drug Addiction a Brain Disease?” is the best-articulated argument against the conceptualization of addiction as a disease (it can be found at http://www.eppc.org/publications/bookID.19/book_detail.asp). Likewise, Dr. Lillianfeld’s effort to expose semantic mistakes in psychology is commendable. However their views on addiction reveal fundamental mistakes regarding the nature of addiction and the experience of the addicted patient.

On the question of language, the authors claim that characterizing addiction as a brain disease appropriates language used to describe conditions such as multiple sclerosis and schizophrenia. Yes, and rightly so. Our modern concept of disease – the “Disease Model” – emerged from Germ Theory over a century ago, and evolved such that today it can be defined as a physical, cellular defect or lesion in a bodily organ or organ system that leads to the expression of signs and symptoms in the patient. This is a very rigorous standard for disease (it is also the standard demanded by Dr. Thomas Szasz, another opponent of the conceptualization of addiction as a disease).

For most of the last century, it has not been possible to fit addiction to this standard. That has changed. The organ involved in addiction is the limbic brain (specifically the ventral tegmentum and nucleus accumbens/extended amygdala). The defect is a stress-induced/genetically predisposed dysfunction of the limbic dopamine system (specifically a hedonic dysfunction – a broken “pleasure sense”). And the symptoms of greatest importance are 1) loss of control, 2) craving, and 3) persistent drug use despite negative consequences. Addiction meets the standard definition of disease better than multiple sclerosis and schizophrenia, two diseases whose pathophysiologies are far less elucidated. This is why medicine can claim, with confidence, that addiction is a disease.

On the question of personal agency and choice, the authors’ complain that calling addiction a “disease” undermines personal agency and our concept of free will. This is not, however, a problem with addiction. The standard definition of disease as it is used in medical practice today strips patients of their power of choice and hands that power to the doctor. In exchange, the patient gets to enter the sick role – a helpless, compliant role, and one relieved of responsibility. So the problem of addicts claiming that they have a disease and must be absolved of responsibility for their behavior is not a problem with addiction. It’s a problem with our standard definition of disease. Most of the authors’ trouble in calling addiction a disease stems not from whether or not addiction fits our standard definition of disease (it does), it stems from the problems inherent in the Disease Model itself.

As for choice, in addition to being a broken hedonic system in the brain, addiction is also a disorder of volition. Craving states cause a selective hypofunctionality of the prefrontal cortex. This is visible on neuroimaging scans such as functional MRI. The area of the brain of particular interest is the ventro-medial prefrontal cortex, an area of the brain that assesses future consequences. It is hard to underestimate the importance of these findings. They imply that choice is a variable quantity during some brain disease states. The exciting opportunity here is to figure out how choice really works. How is it realized in the brain? What are the conditions under which it best operates? And how do we set those conditions so that addicted patients can exercise free will according to their true values?

The authors may be correct in their assertion that these neurological scans may not mean all that their proponents say they do. But they do mean something. At the very least, the activity visible on these scans correlates with conscious experiences such as craving. This evidence, while preliminary, cannot be ignored. Entire fields of scientific research are based on less.

On the question of stigma, the authors support the idea of considering addiction a moral failing. They believe the stigma against addicts is good, and that shame motivates people to stop using drugs. The correct answer here is “sort-of.” Stigma motivates drug and alcohol ABUSERS to get sober. When faced with the negative consequences of their drug use, the abuser can bring these negative consequences to bear on their decision-making. But stigma, or shame, or the threat of prison or death, will not work to change the behavior of addicts because the limbic brain equates drugs with survival at a very deep and unconscious level of brain processing. In light of this and the failure of the “consequence appreciating” areas of the cortex, the utility of stigma and punishment in the motivation of addicts is dubious. When craving kicks in, the drug comes first. The addict literally believes that the best way to stay out of jail is to get high (secure survival) now, and deal with the consequences later. This is the most fascinating and frustrating feature of addiction: negative consequences have no effect on the pattern of drug use. If you really are dealing with an addict, punishment doesn’t work.

As it stands in addiction medicine today, there is no way to tell the difference, not with definitive certainty, between the really bad drug abuser and the not so bad drug addict. The conflation of these two populations – abusers and addicts – creates much confusion. The promise of these neuroimaging scans is that they may someday be able to detect the minute differences in brain activity that differentiate the abuser from the actual addict.

In the meantime, we would do well to remember the long and painful history in medicine of labeling the behavior of people we didn’t like as “badness,” only later to learn something new about the way the brain or body works and realize that these behaviors were, in fact, symptoms – of a disease process. How do we know we are not making the same mistake again with addicts? The risk of being terribly wrong suggests caution. It is a strange specialty of medicine that uses shame as a therapeutic modality or stigmatizes patients to promote health. In fact, medicine’s contribution to the concept of justice lies in its ability to reveal the difference between those behaviors that are, in fact, symptoms, and those that are truly bad. Doctors cultivate an intuition – a “sixth sense” – that tells us: but for the disease process, the patient would not act this way. I get that feeling when I look at addicts.

Lastly, on the question of spiritual change the authors cite the experience of Jamie Lee Curtis as an example of how many addicts enter recovery. In Ms. Curtis’ case, she never went to treatment to get sober; rather she had a spiritual experience and relied solely on her attendance at A.A. meetings. But what got her sober? Was it the shame of some stigma or punishment hanging over her head (a stick)? Was it the reward of a promising career in film (a carrot)? Or was it the fact that she found something that was deeply, personally, emotionally meaningful - in her case, a relationship with God?

These deeply personally meaningful things – which will be individual to each person (“God as he/she understands Him”) – have the power to break the hold of craving. They are spiritual. They restore the function of the prefrontal cortex, and with it the addict’s power to choose meaningful things over drugs. The task of addiction treatment is to teach the addict stress coping tools to decrease their craving, while at the same time helping them find the one thing that is a little more meaningful (a little “higher in its power”) than drugs or alcohol. Or food, or sex, or gambling. A.A. does this nicely, but none of this comes to the patient overnight. Treatment that understands addiction as a disease can be indispensable as well.

So is addiction a disease? Yes. Do addicts need to take responsibility for managing their addiction? Certainly. But so do all patients. So do patients with multiple sclerosis and schizophrenia. The problem I have is in holding one group of patients more responsible than other groups of patients. Most people will take responsibility to the exact extent that they know how, or are supported. That is what good medicine is all about.

Kevin T. McCauley, M.D.

Roughly a Quarter of All Drivers in Some States Drove Under the Influence of Alcohol in the Past Year

2008-05-05T10:54:00.000-07:00

New Nationwide Report Estimates that also reveals that 6-7 percent of adults in several states and the District of Columbia drove under the influence of illicit drugs at least once in the past year.

A first-of-its-kind national report reveals that 15.1 percent of the nation’s drivers age 18 and older drove under the influence of alcohol at least once in the past year. The report says that in some states the levels are far higher – about one in four drivers.

Nationwide, an estimated 30.5 million people aged 12 or older drove under the influence of alcohol at least once in the past year according to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Driving under the influence ranged from a low of 9.5 percent in Utah, to highs of 26.4 percent in Wisconsin, 24.9 percent in North Dakota and 23.5 percent in Minnesota.

The report also shows that nationwide nearly one in 20 adult drivers aged 18 or older drove under the influence of illicit drugs such as marijuana/hashish, cocaine/crack, inhalants, hallucinogens, heroin or prescription drugs used nonmedically.

According to the National Highway Traffic Safety Administration (NHTSA), there were almost 16,700 deaths in 2004 caused by accidents related to driving under the influence of alcohol. Overall, driving under the influence of alcohol and illicit drugs is among the leading sources of preventable death by injury in the United States.

“This report highlights the enormous public health risk posed by this problem – one threatening the lives of many Americans every day,” said SAMHSA Administrator Terry Cline, Ph.D. “By highlighting the scope and nature of this problem in each state we can help communities best use their efforts and resources to address this preventable menace.”

Continuing Care Protocol at Sober Living by the Sea

2008-05-01T12:10:00.001-07:00

If and when a client is returning to their home after completing treatment, they receive a lot of options for continued care. This is where Sober Living by the Sea's twenty three year history benefits the clients because we have a nation wide network of reputable addiction professionals.

I have been tracking the continuing care process and it is quite a production for every client, but it is worth it because we care so much about our client's reaching that one year milestone of sobriety or abstinence from their eating disorder.

Prior to discharge, the Continuing Care Coordinator and the Case Manager will arrange for IOP (intensive outpatient treatment) in the hometown community, followed by meeting with a counselor/therapist specializing in substance abuse, on a weekly basis for support and for someone to check in with about issues arising during this transitional time. We equip every client with several options for addictionologists, therapists, prescribing psychiatrists, outpatient facilities, sober living homes, and of course a directory of twelve step meetings in the area where they are returning.=

Of course, SLBTS is unique in that we offer several levels of continuing care. We are actually a destination for clients to pursure extended continuing care (after primary treatment at another facility). Some of our clients have come from a 30 day treatment to extend their care in an open community with us to practice living sober. Many of our clients come for their first treatment into Newport Beach which has the world's most vibrant recovery community. Of course with several gender specific primary treatment facilities in Sober Living's Newport Beach campus, we also do our fair share of caring for clients from detox through the 1 year mark. Our men's treatment facilities include the Landing for Men, a men's drug rehab right on the beach, and also in the California Foothills we have Sunrise Recovery Ranch for men, which is a very highly supervised and spiritual 12 step based treatment center for addiction in a beautiful location.

For women, we have the Rose of Newport Beach, which is a beautiful and exclusive women's rehab right on the beach in Orange County. Also, for Eating Disorders we have The Victorian for Eating Disorders which is the west coast's premier treatment program for anorexia, bulimia, and compulsive overeating.

Either way, a powerful milestone is 1 year of recovery which is the best prognosticator for long term recovery. The best case scenario for achieving this is to gradually step down in care, from 90 days of residential, to Extended Work/School Program, where an additional 90 days is spent going to school or working during the day and returning to SLBTS to continue their care in the evenings. A further step might be to move out to a sober living home and continue to attend SLBTS in the evenings. All the while, continuing to meet with a case manager weekly and continuing with drug testing.

I like to recommend that a client continue to meet with a therapist weekly until they have 2 years of sobriety. Of course, during this time, the client would continue to attend meetings, meet with their sponsor, and continue step work. I say it is always better to stay in treatment longer from the start, than to go it alone too soon, then have to start all over again if your way doesn’t work out.

From Clinician Tany DesLoover - Treatment Frequently Asked Questions - Families and Clients

2008-04-28T11:54:00.000-07:00

Frequently asked questions - from family members
The most frequently asked question I get from families is, “When will my child, spouse, parent, express remorse for what they have put me/us through? I don’t hear any apologies”. This usually occurs after their family member has been here in treatment for a couple of weeks and in talking about how they are doing, or “coming along”. I explain that what they are talking about is “amends”, which are addressed in the 8th step of recovery. Currently, their recovering person is working on step 1, understanding that they are powerless over their substance of choice. That the 8th step may be months away. It’s helpful to remember and try to separate the person from the disease.

Frequently asked questions - from recovering client

The most frequently asked question I get from the family member in treatment is, “Why don’t they trust me? I’m in treatment aren’t I?” I ask them how long they have been using, and let them know that their family may not trust them until they have been sober as long as they were using. It takes time for them to learn to trust. They have been through an extraordinary ordeal, much of which of which the substance abuser does not even remember…!

Postscript
Recovery is a process and takes patience. Treatment is no panacea; Recovery is a journey for the whole family. It took a long time to get to treatment and it takes a while to put things back together again, or for the first time for some people. Remember that it is an illness, and like cancer, long term recovery works best if everyone is learning to take care of themselves with outside help.

George Bush Discusses His Recovery From Alcoholism

2008-04-25T11:12:00.000-07:00

Who says you can’t still do great things even after going to rehab?

George Bush became very emotional and opened up about his alcoholism to a group of people attending a speech he was making at the Jericho Program in Maryland on Tuesday, January 29th, 2008. The Jericho program is a faith based community service program that helps men re-enter society after leaving prison.
George Bush has been sober since his 40th birthday and had to reach out for the help of a faith based program. During his speech he also made reference to the 12 Steps of Alcoholics Anonymous.

"Addiction is hard to overcome. As you might remember, I drank too much at one time in my life," said Bush, who has often stated that religion became a greater part of his life after he gave up alcohol.

"I understand faith-based programs. I understand that sometimes you can find the inspiration from a higher power to solve an addiction problem," he said.

George Bush has become increasingly vocal about his struggles with alcoholism, also talking frankly with struggling group of young addicts who he hosted in the White House in December. George Bush’s date of sobriety is July 6th, 1986.

More Scientific Progress about Addiction, Dopamine

2008-04-21T12:30:00.000-07:00

Those of you who were ever clients at SLBTS will remember the phenomenal lectures given by the excellent Dr. Kevin McCauley about the disease model of addiction.

Kevin McCauley's lectures help our clients understand the medical phenomenon that is affecting them and causing them to experience craving because of the surge of dopamine that their midbrain associates with using drugs or alcohol.

To anyone who remembers their addiction education at Sober Living by the Sea, it will come as no surprise that Researchers at Brookhaven Lab have shown that increasing the brain level of receptors for dopamine, a pleasure-related chemical, can reduce use of cocaine by 75 percent in rats trained to self-administer it. Earlier research by this team had similar findings for alcohol intake. Treatments that increase levels of these chemicals - dopamine D2 receptors -- may prove useful in treating addiction, according to the authors.

Yet more scientific progress in the treatment of addiction....

http://www.bnl.gov/bnlweb/pubaf/pr/PR_display.asp?prID=08-33

The Genetics of Addiction

2008-04-17T09:42:00.000-07:00

There is often a very lively discussion on the Sober Living by the Sea Campus about the extent that genetics play in the development of addiction.

There is always a hope in the recovery community that "science may one day" provide a solution that will make the changing of addictive behavior much more effortless than it currently is. By identifying genetic components that predict addiction, there is hope that science is progressing to the point where people suffering from chemical dependencies can get a supportive medical regimen that will make it an "easier, softer" process.

There is a new relsease from the National Institute of Drug Abuse indicating that that more research is performed on the genetics of addiction, the more evidence there is that there are genetic components that predict individuals predisposition to addiction. The latest study results focus on nicotine.

Is this a reason to hope that the treatment of addiction might be poised for a breakthrough in the near future? We are all watching and waiting...

http://www.drugabuse.gov/newsroom/08/NR4-02a.html