Monthly Archives: March 2013

Why the need for certainty ?

The need for certainty in life may often present itself as a need for total security or total safety, and may seem a very natural and obvious need that many people strive for.

When dealing with alcoholism and people who have entered a rehab, this question of the need for certainty takes on a very different context.

There are two specific areas of concern that need to be addressed upon entering a rehab.

Firstly is where this need for a total sense of certainty has come from, and secondly what this supposed need has led the alcoholic to become in terms of their attitudes and behaviours.

Whilst there are no statistics to back this up, there is a general acknowledgement amongst the world of people who work in alcoholism, and people in AA, that a significant number of alcoholics were born into and/or grew up in alcoholic homes.

An alcoholic home, as a general term, refers to a home where one or more of the parents or even possibly grandparents or significant others were or are active alcoholics.

The importance of this, is the effect it has on the alcoholic themselves, both in childhood and much later in adult life.

The nature of growing up in an alcoholic home for most people manifests itself in the feeling of a lack of safety, a lack of certainty about anything.

This lack of permanence leads the child or kid to crave some level of safety, security or certainty.

They will often take this need for safety or certainty to extreme levels, often to areas where they feel they have some level of control over.

When entering a rehab many years later, that feeling of certainty safety and control will most likely have evaporated.

Obviously this need for certainty is not restricted to people who have grown up in alcoholic homes. Any child who has grown up in a home where parents have not provided that sense of safety for whatever reason will have similar issues.

Whilst this may not cause a person to drink or become addicted to substances, this lack of safety or certainty will provide a huge emotional drive for that person to try and provide that sense of safety for themselves.

This virtually always manifests itself in a need for certainty, which is itself an illusion.

Part of the job of a rehab is, in a very short period of time, provide some of the insights into the emotional drives of the alcoholic that can help them come to terms with their illness, and help begin the process of freeing them from some of the more destructive elements of those emotional drives.

The willingness to look at these things has to come from within the person themselves, and often the time spent in a rehab is too short to really come to terms with that. In that context the people who work in a rehab, in a therapeutic nature, will realise that the most they can do is provide some context for the alcoholic, without giving them a belief that those conditions caused them to drink.

It is always difficult to generalise about what a rehab should or should not do, but it is certainly true to say that the very nature of a rehab does provide some temporary certainty, albeit for a short period of time.

This period of time can be best used at different levels by different people.

The effectiveness of the work done in a rehab, both therapeutically and spiritually, will depends to a large extent on the approach taken by the alcoholic entering a rehab, and by the people who work there.

The benefit of that work or its effectiveness will not be known for probably quite a while after the person has left rehab, and hopefully been able to rebuild their inner world within a safe environment where they have been able to stay sober.

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What is trust in God ?

The concept of trusting God begins for most people in childhood, with a sense that it adds a level of safety to the safety that a child hopefully feels within their family.

It is unlikely to be spelt out in detail what this means, but will most likely be a felt sense of trust that is more likely to be seen as an extension of a sense of trust or safety that already exists within the family.

The nation of trusting in God will be reinforced by the by such rituals as night-time prayers, going to church, Sunday school, Bible reading etc.

In other scenarios many families and many parents verge on somewhat of the religious neurotic, and use the notion of God as an image almost to escape their own lack of a sense of safety or the ability to provide an emotionally safe environment for their children. In this context the notion of trusting in God takes on a very different meaning, a more sinister one in affect.

When entering a rehab, as when first attending meetings of Alcoholics Anonymous or Narcotics Anonymous, many people are confronted with the word God, and the implications that this word brings up in them, normally as a legacy of their childhood experience.

A rehab will most likely promote the 12 step programme of Alcoholics Anonymous, which is by its very nature focuses on the world of the spirit and of God.

A rehab will have many different approaches to how it deals with people’s antagonism or outright hatred of religion, or any meaning of the word God.

This will be a huge part of a person’s recovery, not least because many people entering a rehab will feel they have lost their sense of choice about what they do.

If a rehab focuses on telling people that they are effectively need to disempower themselves even more by relying on some sense of God that does not work for them, they will merely deepen that sense of hopelessness that the alcoholic is likely to feel on entering a rehab.

A rehab is likely to focus on the first five steps of Alcoholics Anonymous, although the interpretation of what they mean is often significantly different to that which the AA program actually refers.

What will arise, is the question of what trusting in God actually means, and how an alcoholic can begin that process.

This will inevitably raise the question of what the word God means for the alcoholic, and hopefully a rehab will be sensitive to this and help a person explore the different meanings open to them.

The book Alcoholics Anonymous, on which the Fellowship of AA is based, makes continual references to God, spiritual experience, spiritual awakening etc.

At the same time the book does not try to define what these terms means, but makes it pretty clear that it should be a freedom for the individual to discover what these terms mean to them.

It should be a big part of the function of a rehab to reinforce this freedom, although sadly this is not always the case.

The other thing that the big book of Alcoholics Anonymous continually implies, is that a sense of God or of spirit is primarily to be found within the person themselves rather than externally.

This gets to the whole question of the nature of God etc which is much better left alone, in this context.

A big part of the function of a rehab is to provide a safe environment, where an alcoholic can begin the process of rebuilding their life and their inner world.

Learning to trust in God, primarily means learning to trust in themselves first, and using that as a freedom to discover what God means to them, and what trusting in that God actually means.

A rehab should encourage this freedom, even though it obviously brings a level of uncertainty with it, a position that a rehab might find uncomfortable given its very structured and focused environment.

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How do you rebuild trust ?

There is an implication in the question, that trust has been broken in some way and needs to be rebuilt by one or two parties.

The whole question of trust and what it means to people is a hugely important one in recovery, as in life generally. In childhood, ideally a child will learn to trust the significant adults in their lives.

A child will think of this in terms of safety rather than the adult concept of trust. A child hopefully will feel safe with an adult, and in some sense that will free them to be themselves and have what they consider to be a safe relationship with that adult.

As adults, we tend to talk about trusting or not trusting people rather than feeling safe with them.

Trust in many ways is a very natural process, although we often tend to talk about distrusting people rather than trusting people.

We tend to make judgements about who we trust and who we don’t trust based on our instincts.

Sometimes these instincts are right and at other times they let us down.Entering a rehab will normally make an alcoholic assume that their instincts and their need for safety has completely deserted them.

And then there is God.

What people mean when they say that they trust God can have a huge number of different interpretations.

For some people it is about trusting an unknown sort of supernatural force who is in control of life.

For other people it is about trusting some type of energy in the universe, and for others it is about trusting God within ourselves.

There are of course other meanings and interpretations. What is rarely talked about, but is key to rebuilding trust is the notion of trusting yourself, which is a key issue for someone entering into a rehab.

An alcoholic will have most likely destroyed trust in themselves, people close to them, family and work colleagues and other people in their lives. It is unlikely they will have done this deliberately, though in certain cases that could well be true.

It is more likely that they have destroyed trust almost as a by product of their need to drink, and to construct a life where they feel safe enough to drink and to be able to get away with it.

This inevitably will have consequences, sometimes severe, both for the alcoholic and for the people close to them.

In a rehab, the process of rebuilding the life of an alcoholic should hopefully start to take place. At some level an alcoholic is likely to feel threatened in a rehab, simply because they are likely to feel under attack, either about their drinking or their life as a result of the drinking.

A rehab may talk about the issue of trust or not, but indirectly it will begin to address the issue of safety within the alcoholic.The notion of beginning to trust yourself normally begins for most of us in childhood, and hopefully becomes a natural part of our lives.

For an alcoholic entering into a rehab, the whole process of rebuilding their lives is about to enter a new phase.

A rehab should have enough of a structure and a wide enough range of therapeutic techniques to begin the process of helping the alcoholic to begin to rediscover themselves as a person.

This will involve understanding at some level the nature of the illness and why there are in a rehab, and what they can do to begin to heal the inner conflicts which will have been a major drive, emotionally, in their alcoholism.

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Research into high energy levels and alcoholism

Research into why people drink excessively, become alcoholics, or simply heavy drinkers with an alcohol problem (if there is such a thing) is a hugely complex area because of the diverse nature of people, alcohol and the effects of alcohol on people.

This piece of research done at Yale, and published in the Journal of Clinical Investigation, is potentially very significant because it identifies one of the factors that most alcoholics in recovery would confirm – that alcohol can induce a sense of energy to the brain. In the book Alcoholics Anonymous, a doctor writes something to the effect that alcoholics drink because they like the sensation that alcohol effects within them.

It is certainly true that alcohol can produce a different effect internally on alcoholics that it does not affect on people who are not alcoholics. Understanding what that effect is and how it contributes to the illness of alcoholism is hugely important. This piece of research could make a significant contribution to that evolving debate.

The research is titled

Increased brain uptake and oxidation of acetate in heavy drinkers

Abstract

‘When a person consumes ethanol, the body quickly begins to convert it to acetic acid, which circulates in the blood and can serve as a source of energy for the brain and other organs. This study used  13C magnetic resonance spectroscopy to test whether chronic heavy drinking is associated with greater brain uptake and oxidation of acetic acid, providing a potential metabolic reward or adenosinergic effect as a consequence of drinking.

Seven heavy drinkers, who regularly consumed at least 8 drinks per week and at least 4 drinks per day at least once per week, and 7 light drinkers, who consumed fewer than 2 drinks per week were recruited. The subjects were administered [2-13C]acetate for 2 hours and scanned throughout that time with magnetic resonance spectroscopy of the brain to observe natural  13C abundance of N-acetylaspartate (NAA) and the appearance of13C-labeled glutamate, glutamine, and acetate.

Heavy drinkers had approximately 2-fold more brain acetate relative to blood and twice as much labeled glutamate and glutamine. The results show that acetate transport and oxidation are faster in heavy drinkers compared with that in light drinkers. Our finding suggests that a new therapeutic approach to supply acetate during alcohol detoxification may be beneficial.’

J Clin Invest. doi:10.1172/JCI65153.

Published March 8, 2013

Full article on The Journal of Clinical Investigation website, click here

For homepage of Graeme mason, lead rsearcher , click here

For the main Yale website, click here

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Targeting young addicts

Article about how authorities in southern California are aiming to crack down on heroin addiction amongst young addicts

‘A heroin addict for years, Taylor Beatty is 22 years old, has been sober for a month, and says she faces a daily struggle against the drug that is addicting an increasing number of young people.

“I started using at 12 and this has been the biggest struggle I’ve had to go through in my life,” she said.

Taylor has been homeless for several years trying to regain her family’s trust. She recently overdoses and said she didn’t think she was going to make it. Luckily, she did.

Now, she’s in her 17th treatment center.’

Full Story – NBC

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Rise in Prescription Drug Addiction

‘Can you name the leading cause of accidental death in the United States now?

 

It is prescription drug overdose.  Since 2009 death from legally prescribed narcotics has led auto accident deaths as the number one cause of accidental death in the United States.  More than 15000 die now annually.

 

How can we explain and try to understand the rise in legal narcotic misuse and addiction?

 

The answer: Not easily.  I believe that the problem has complex roots, including the failure to perceive correctly the breadth of the problem or the sources of the drugs.

 

For instance, if you were to ask someone to describe what comes to mind when they think of a drug addict, most likely the answer would be a picture of an individual in a crack house who is nodding out on cocaine or heroin; the picture is a myth.

 

The fact is that deaths due to legal pain medication far outstrip the number of deaths due to illegal drugs.’

 

Full Article – Kevinmed

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Reality of Addiction

Very moving story by mom of an Ontario 21-year-old who accidentally  overdosed on fentanyl, having struggled with addiction for a long time.

‘After struggling with addiction and mental health issues for years, Lockie accidentally overdosed on fentanyl, a prescription opioid painkiller vastly more powerful than morphine.

“In the end I think he just didn’t realize that addiction was bigger than he was,” said his mother, Monica Lockie. “He was superintelligent and really felt that he knew more about the drug and was able to navigate his way around it. He didn’t really think that drugs would ever beat him.”

Full story – Metronews Canada

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Science of addiction

Can’t vouch for the scientific accuracy of this, but a very well thought out and presented article on the science of addiction, showing in very simplistic terms and diagrams some of the main beliefs about addiction and how it works in the human brain.

Dr Urban D’Souza, School of Medicine, University Malaysia Sabah

“You are unable to stop when you want to, despite being aware of the adverse consequences. It permeates your life; you spend more time satisfying – Dr Nora Volkow

Addiction is the repeated or continued use of any mood altering drug/substance or also a behaviour that involves adverse dependence. It may be due to neurological problems or may be neurological impairment leading to such behaviour. Addiction may include nicotine, alcohol, drugs, exercise, sex, gambling or also internet usage!”

Full story – DaijiWorld

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Drug Addiction – Harm Reduction or Abstinence ?

Interesting article concerning the approach by British Columbia to dealing with its problem of drug addiction.

Basically a contrast between the different merits of various harm reduction techniques employed, against a complete absence of all drugs.

Although this article focuses on the attitude of British Columbia, Canada – it is a debate that is highly applicable to everywhere that is trying to grapple with this problem.

”In other words, why are the taxpayer-funded authorities so focused on harm-reduction methods (including providing free needles, crack kits and hash pipes) that they reject funding for abstinence-based recovery programs, denying addicts a scientifically-supported treatment option?

I’m not the only one asking this. Abbotsford-Mission MLA Randy Hawes, whose son beat his drug habit through an abstinence-based program, says it was one of the issues that frustrated him and other Liberal MLAs who last fall questioned the authorities about it, through the health minister’s office.”

Full Story : The Province

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Conflict and Confrontation

The very words conflict and confrontation often make people immediately wary, and many people will immediately back off any situation that could give rise to either of these two possibilities.

This is true to an extent even in an alcoholic home, which is likely to have experienced extreme examples of conflict and confrontation quite possibly for a very long time.

When an alcoholic enters a rehab/treatment center it is quite likely that the dynamic of the family home has become extremely bitter and twisted.

There are likely to be many reasons for this that can take quite a long time to unpick.

A rehab that is really focused on the long term good of the family will realise that an initial period of separation by the alcoholic and the family can give both parties a space that is desperately needed.

It is also part of the job of a rehab to prepare both parties to move forward again after the alcoholic has left a rehab/treatment center.

This is a bit of a generalisation based on the assumption that an alcoholic is living at home with a family.

This is not always true but is a fair enough model for people to draw distinctions from.

A rehab will certainly work on the basis that whoever has been in an alcoholic’s life with them prior to admission to a rehab/treatment center will have been in a serious amount of conflict with them.

The nature of conflict and confrontation in an alcoholic home is not normally a healthy one.

Conflict and confrontation can be extremely healthy, when approached by people who are genuinely trying to resolve difficult situations.

A rehab/treatment center will be a place where an alcoholic is admitted to largely because their own life has at some level broken down so much or become so unmanageable that they cannot carry on on their own.

Part of the process of that unmanageability will have been a very unhealthy relationship with most of the people, which may not be many in number, left in the life of an alcoholic at that point.

A rehab/treatment center will in some sense be a safe place physically, and emotionally, where the different parties can begin to get some distance from each other and hopefully see some of the distortions behind their thinking that have generated much of this ununmanageability.

Part of this conflict and confrontation will be what is known simply as the blame game.

The nature of blame is quite a complicated one, suffice to say that an alcoholic is likely to blame pretty much everyone for what is going on in his or her life, and the family is likely to blame the alcoholic for the problems in their lives.

Whilst some of this may be true, it is unlikely all to be true. Whilst in a rehab, the alcoholic will have time to begin to own some of this anger and blame, and dump it in the rehab, either on staff or in some type of group therapy.

This is actually an important function of a rehab, and should be encouraged.

There is always a danger that long-term, an alcoholic will simply carry on trying to blame other people for their lives.

That is out of the control of a rehab and its environment, and is more to do with the long-term mental health of the alcoholic themselves.

Part of the job of a rehab is to open up a sense of awareness of alcoholism and how it affects people.

It is quite likely that a rehab will want in patients to attend meetings of Alcoholics Anonymous or Narcotics Anonymous, and their awareness of the illness will be deepened by such attendance.

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