Are You or Someone You Know Almost Addicted to Drugs?

Just because someone doesn’t meet diagnostic criteria for substance abuse or dependence doesn’t mean drugs aren’t damaging their world.
There’s a space between normal behavior and an official diagnosis called “almost addicted” that has serious consequences, according to Dr. J. Wesley Boyd, MD, Ph.D, an assistant professor at Harvard Medical School and author of the book Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
People who are almost addicted still struggle because of their drug use. They may have problems in their personal or professional lives. They also might meet criteria for drug abuse or dependence in the future — at which point it becomes tougher to treat. Intervening now can lead to healthy changes and prevent a full-blown crisis, said Dr. Boyd, also a staff psychiatrist at Cambridge Health Alliance.

Warning Signs of Almost Addiction

People with drug problems are easy to spot. This is actually the biggest myth about drug use, Boyd said. One of his first patients was a professional who was using hundreds of milligrams of oxycontin, every day, for over a year. His wife had no idea. His co-workers had no clue. And there were no complaints about his work performance.
(He finally got caught after a pharmacist called the police. Fortunately, after treatment, years later, he was still drug-free.)
But there are signs to look for. In Almost Addicted Boyd features the Drug Abuse Screening Test (DAST) along with other key questions. These are some of the obvious and not-so-obvious signs he mentioned:

• Abusing prescription drugs
• Inability to get through the week without using drugs
• Feeling guilty about drug use
• Having loved ones worry about your drug use
• Being told by loved ones that your behavior is strange
• Losing friends over drug use
• Losing a job over drug use
• Engaging in illegal activities to get drugs
• Not giving your full effort at work because of drug use
• Writing work emails or doing other things online while under the influence and regretting them later
• Divulging important information about work while under the influence
• Embarrassing your family
• Berating loved ones while under the influence
• Cheating on your spouse while under the influence

How Loved Ones Can Help

There are many things loved ones can do, Boyd said. These are his suggestions:
Don’t enable the behavior. Don’t make it easy for your loved one to keep abusing drugs, Boyd said. Consider how you might be feeding their habit. Take the example of a mom who was giving her teenage son money for lunch and the mall. He kept asking for more money more often. Turns out, as he told Boyd, he was using the cash to buy drugs.
A loved one also might make excuses for a family member who misses work after a night of drug use. “Covering for the behavior allows it to continue longer than it might,” Boyd said.
Talk to your loved one – and stick to the facts. When approaching your loved one, be as straightforward and objective as possible, Boyd said. It’s certainly easier said than done, but try to keep your emotions out of the conversation.
“Whether they’re almost or full-on addicted, most people live in denial,” he said. So if you tell someone “I think you’re abusing drugs,” they’ll likely just deny it. Instead, let the facts drive your conversation. Say “I noticed your eyes were bloodshot and you showed up late to work.”
Ask others to step in. If your loved one is in denial, gather support. For instance, if the person is religious, ask a clergy member to speak to them, Boyd said. If they’re not religious, ask a primary care physician, he said.
Employ leverage. If your loved one refuses help — or again is still in denial — Boyd encourages families to employ any leverage they can (within legal limits, of course). In the adolescent substance abuse program at Boston Children’s Hospital, Boyd and his colleagues use the 7 Cs of leverage: cash, credit card, checks, car, cell phone, computer and curfew.
When you have little or no leverage, rely on the law. For instance, while it’s incredibly difficult, if your loved one is facing legal charges, Boyd advises families to “let the law run its course.” Often, he said, these individuals will be put on probation, which includes drug testing. As he said, “any period of enforced sobriety is better than no sobriety.”

What You Can Do

If you’re the one who’s almost addicted, consider your relationship with the drug openly and honestly, Boyd said. See a mental health professional who specializes in substance use or a primary care physician, he said. Attend support groups such as Narcotics Anonymous or Alcoholics Anonymous. “The only request for going to these meetings is the desire to stop using your substance,” he said.
Some people may be able to quit on their own, Boyd said. For instance, since her teenage years, Boyd’s mom smoked two packs of cigarettes every day. After learning she had early emphysema, she quit cold turkey.
However, if any aspect of your life is at risk – such as your ability to work or keep your home – or there’s an immediate threat to your health, seek professional help right away, he said.
No one is immune to addiction, Boyd said. One of his supervisors, a substance abuse expert, used to say, “As far as I know the reason I’m not a heroin addict is that I haven’t tried heroin.”
Even casual use can become too much. If you’re almost addicted, seek help. If your loved one is almost addicted, offer help.

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Staying Sane & Sober in Order to Survive the Holiday Season

I remember when I was an active addict. Before I crashed and burned and slowly recovered. I remember holidays, particularly Christmas, sort of like I remember a glass of red wine — defined by longing but also by despair.
I was able to stop drinking but, like many recovering addicts, I find holidays particularly tough. They can be a dangerous time when recovering from addiction.
My family and friends celebrate the holiday season as many people do — with lovely meals and gifts, gratitude and festive drinks.
I recall my first Christmas sober, three years ago, and the concerted effort my family made, celebrating with more eggnog and less rum. They knew that, early in my sobriety, I was triggered by even the sight of alcohol. Driving past a liquor store would cause my heart to beat quicker. But as the years have passed, and I have become more comfortable in my sobriety, so have they.
Last year, I was surrounded by the bottles I once loved, the liquids I still adore in memory, as my family held their annual Christmas party. No longer did they tip-toe ’round my sobriety and while I was grateful for this sense of normalcy, I was frightened.
I was not frightened because I felt I would relapse and pour rum in my eggnog. I was frightened because alcohol, once a fast and best friend, surrounded me.
I spent a couple of hours talking to people, just enough to pass for being social, and then locked myself in a spare room with a book. The hours passed and laughter become light conversation until the house was blissfully quiet again.
With this year’s holiday season quickly approaching, I plan to deal with the situation differently. I plan to stay sober, just as in previous years, but with less fear.  I have, thankfully, found and maintained relationships with those who are also recovering addicts. I asked them how they felt about sobriety and the holidays. They find it difficult as well. It’s a bit like walking into a bar except you cannot walk quickly away.
A friend who has over a decade of sobriety under her belt told me that the longer one stays sober the easier it becomes to attend events with alcohol and not feel anxious and afraid. Another, new in his sobriety, recognizes his limitations. If he feels uncomfortable in a situation he gracefully leaves. Maintaining sobriety is the most important thing a recovering addict can do.
Addiction is a dangerous disease and the road to recovery is paved with events, holidays and gatherings that remind us that we may still be fragile. But it is this knowledge that allows us to grow.
This year, when I see a bottle of red wine, I will not hide in a spare room with the door locked. I will remember that my sobriety is defined by sanity and in order to stay sober I need to expose myself to the things which scare me.
Someone enjoying eggnog and rum? That’s a good place to start.

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Up in Smoke: Do Smokers Think More about Death?

I have a poster in my office from the 1950s. It’s yellowed with the passing of years, but it still makes me smile. A man is changing a tire in the snow and the situation isn’t going as planned. He has a  grimace on his face and tire chains are wrapped around his wrists like shackles. A woman is standing over him with a pack of cigarettes. The text reads:
“When tempers need to be controlled… Why be irritated? Light an Old Gold!”
Times certainly have changed. Societal views on cigarettes, and toward those who smoke them, have been flipped upside-down. Smokers are segregated. They must stand fifty feet away from shopping centers, hide in a bush when they see a child, douse themselves in perfume or cologne before leaving their homes.
Sarcasm aside, smoking isn’t popular anymore, nor is it attractive.

I came across a small article by Karen Schrock in Scientific American Mind entitled “How Smokers Think about Death”. What a headline that is!
Let me preface this by telling you I smoked cigarettes for over 10 years. I’m 27 now and I’m pretty sure I cannot tell you how I think about death. Actually, I cannot think of a single smoker whose claim to fame would be knowing more about death than the nonsmoker sitting beside them. Mortality isn’t really a casual lunch conversation.
The article asks the question: “Do graphic warning labels on cigarette packages really deter people from lighting up?” Schrock explains that, “In 2012 the U.S. will join dozens of nations around the world in labeling cigarette packages with large photographs of diseased organs, amputated limbs and other gruesome images. Previous research has borne out the idea that when people see images of cigarette-induced ailments, they are reminded of their own mortality.”
When I purchased cigarettes before I quit smoking, the images on them, certainly gruesome, would bother me for about five seconds. Give or take five more seconds. I just wanted a cigarette. But I also wanted to take a black marker to the package and scribble out the pictures. I was not reminded of my own mortality but was instead embarrassed.
The author explains that Jamie Arndt, a psychologist, “…had student smokers complete questionnaires designed to induce either thoughts of their own mortality or thoughts about failing an exam… the researchers offered the students a cigarette and measured every person’s smoking intensity — each puff’s volume, flow and duration.”
I kept reading, hopeful that I might learn something, anything at all at this point.
Schrock continues, “Students who did not smoke often indeed smoked with less passion after being reminded of their own mortality, as compared with the light smokers who read about failing an exam… the infrequent smokers may have been responding to thoughts of death by trying to reduce their own vulnerability… Students who were heavy smokers reacted to thoughts of death by taking even harder drags on their cigarettes.”
So what have we learned courtesy of a 284-word article in a consumer-friendly magazine?
That’s open to debate, much like the impact graphic images have on those who smoke. But it’s safe to say that those who smoke probably do not “think about death” in any fantastical or behavior-changing way.
In the end, whether a person smokes or not, we all question our mortality. That’s part of the human condition. And so are articles that try to figure the whole thing out — life, such as it is.

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Addiction and the Holidays

Ah, the holidays: Candy canes, cozy slippers, festive lights, family peace, marital joy, and grateful children.
Or not.
The holidays are stressful. There are the challenges of too much family, not enough family, not enough money, continual exposure to food and alcohol, and perhaps worst of all, the gap between our actual life and our fantasy life. As if gazing into the perfect happy scene within a snowglobe, we might fall into a trance of how our life should be.
We might feel torn apart by nostalgia and grief over the good times and good people of the past, and wracked with guilt and inadequacy for failing to create a more wonderful life for ourselves. We might feel scared about our dissatisfaction and hypnotized by the promise of fulfillment just beyond the hard glass.
Addictive and codependent behaviors thrive during this season of fantasy.

We use our drugs and habits to escape the pain, while imagining how we will miraculously make changes, always tomorrow, or next week, or next year. We frantically try to keep our idea of the all-good holiday alive through our codependent behaviors, imagining that we have the power to make sure that everyone else is happy and no one gets upset, while suppressing our own feelings of anger and disappointment.
So what should we do about our addictive or codependent behaviors during the holidays? Should we just give up and wait until January 1? Or is there hope for progress now?
One option involves using the holiday season to take an honest and compassionate look at our current behaviors. Instead of using up all of our mental energy imagining how our life used to be better, or how our life should be different, or how we need to change, we can turn our minds and eyes toward simply observing present reality.
We can watch our relationships with alcohol, marijuana, cigarettes, chewing tobacco, prescription and non-prescription drugs, gambling, pornography, video games, television or Internet videos, social media, food, exercise, work, and shopping. We can ask ourselves: How much are we using? How much of our time does it consume? How much money are we spending on our habits? How long have we been using? Is it increasing, decreasing, or remaining constant?
We can watch our relationships with our loved ones. We can ask ourselves: How much of our energy is being devoted to worrying about or trying to control other people’s addictive behaviors? How much are we being controlled by fear of others’ reactions to our boundaries or limits?
Then we can ask ourselves: why are we doing this? What purpose does it serve? What immediate rewards do we attain? In what ways are our behaviors fulfilling our needs? Are there feelings of shame, anger, sadness, loneliness, anxiety, or depression tangled up in our habits? How do these feelings lead to our behaviors? How do these feelings result from our behaviors?
How are our habits affecting our physical health? How are our behaviors affecting our relationships with others? How are our drugs, habits, or relationship patterns affecting our work life? What are the short- and long-term benefits and costs?
As we watch and explore our behaviors in an open and neutral manner, we set the stage for our growth toward increased health. We emerge into the New Year with information about ourselves that we need in order to develop a plan of action, if we so choose, toward change. And by being more honest with ourselves and more present in the life we currently are living, we have broken the paralyzing spell of fantasy: We have begun moving toward a better life.

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Habit Formation and the Rat Race

In October 2012, researchers at the Massachusetts Institute of Technology (MIT) set out to find if they could exercise complete control over habitual behaviors in mice.
By inhibiting a small region of the prefrontal cortex — region of the brain responsible for planning and thought — the scientists were able to break the mice’s habits, but, to their surprise, the mice immediately began forming new behavior patterns.
Until now, psychologists and behavioral therapists believed that habits were hidden in the illusive “subconscious.”
But the MIT study shows that the brain is not just aware of habits: it controls them completely, moment by moment. And no matter how long the habits have existed, we can now shut them off, as by the flip of a switch.

The researchers formed habits through repetition and aural cues in mice running through a simple maze over the course of a few weeks. Once they had shown that the habit was fully ingrained, the researchers broke it by interfering with a part of the prefrontal cortex known as the infralimbic (IL) cortex. Using optogenetics, a technique that allows researchers to inhibit specific cells with light, the researchers blocked IL cortex activity for several seconds as the rats approached the point in the maze where they had to decide which way to turn.
The mice’s brains turned from a reflexive, habitual mode to a more cognitive and engaged mode, focused on a goal. Once the mice had broken their old habits, they formed new ones, which the researchers were then able to break again. But the researchers were in for another surprise: the mice immediately regained their original habit. This suggests that habits are never really forgotten, just overwritten or replaced with new ones.
From an evolutionary standpoint, habits make survival simpler by allowing us to make decisions almost automatically, freeing our brain to think about other things as we perform routine tasks. Our brain tends to find familiar, repeatable behaviors out of a sense of security. The problem with “automatic” behaviors is that they leave us vulnerable to forming negative habits, such as procrastinating on bigger projects or smoking cigarettes when driving.
Many fledgling habits go unnoticed because people rarely engage in meta-cognition when undertaking everyday tasks, where habits are likely to form. In fact, as behaviors are repeated in a consistent context, there is an incremental increase in the link between the context and the action — the behavior becomes more automatic. Our habits are a reflection of how we choose to spend time interacting with the world, guided by our short and long term goals — some of which we have had since childhood or seem inexplicable.
When we enjoy certain stimulation, chemicals such as dopamine are released into the brain, relieving stress, improving mood, and providing a sense of reward. But as we repeat the behavior, our tolerance builds, requiring more stimulation to trigger the dopamine receptors.
Sometimes we keep using just to feel normal (dependence), but if the consequences of our behavior become significant and harmful, and the behavior cannot be controlled, our habit is then considered a behavioral addiction, or a process addiction; if it involves illegal or misused substances, it is considered a drug addiction. Those who form “drug habits” often struggle with them for the rest of their lives due to the lasting effects of dependence and dopamine withdrawal on the brain. Like the mice, our old habits are always lurking in the back of our minds.
The ability to break habits in mice may seem like the nexus of a “cure” for addictive behaviors, but it is unclear how inhibiting the IL cortex will affect humans, whose prefrontal cortex is considerably more complex. It is not absurd to imagine a surgery or drug which could hinder the IL cortex in humans, allowing us to escape our negative habits and live reasonably, consciously, unburdened by our old, learned behaviors, but it may not be necessary.
The key to breaking bad habits is becoming aware of the behavior (through friends, family or any support group available); identifying the factors which trigger and encourage its persistence; and altering them however possible.
Similar to describing the feeling of a dream, the context of a habit is important, too: look for indicators and symbols in your everyday life that may stand for something of greater significance and purposefully change their meaning. Keeping a varied schedule is also a passive way to curb habit formation (variety is the spice of life!).
Once you’ve broken the habit, however, remember the mice: you must seek new, positive behaviors that give you a cerebral boost, such as exercising creativity or problem-solving, to keep your brain balanced and healthy.

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The Problems with the U.S. Addiction Treatment System

Did you know that most addiction treatment specialists have little formal education or training in addiction? Fourteen states require only a high school diploma or a GED to become an addiction counselor; 10 require only an associate’s degree.
But it gets worse — fully 20 states in the U.S. don’t require any degree, or don’t even require addictions counselors to be certified or licensed in any way.
Is it any wonder then that many addiction or rehab programs still rely on an outdated model that’s directly dependent upon how long companies are typically reimbursed for treatment — 30 days? Or that many programs still use treatment methods largely unchanged from the 1950s — not research-backed, modern approaches to treatment?
A groundbreaking report published last year from Columbia University lays out the sad facts of addiction treatment in the U.S. As the report notes, “Some [treatment programs] promise “one time” fixes; others offer posh residential treatment at astronomical prices with little evidence justifying the cost. Even for those who do have insurance coverage or can pay out-of-pocket, there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”

These eye-opening facts come from a report published last summer by the National Center on Addiction and Substance Abuse at Columbia University. The New York Times has the story, including noting that one of the most popular myths about effective addiction treatment is that you have to go to an addiction or rehab center in order to be treated:

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.
Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Just over 43 percent of addiction treatment spending is spent at those specialty addiction treatment centers — the ones that inevitably discharge patients after 30 days, whether they’re successfully treated or not. That’s the biggest chunk of the addiction spending pie.
Successful addiction treatment is difficult — just 42 percent of those who seek out treatment for addiction complete it. That’s not surprising given the characteristics of addiction, and the fact that more often than not, an actual addictive substance is involved. But a system that focuses on evidence-based treatments could do a better job and substantially increase that number.

This profound gap between the science of addiction and current practice related to prevention and treatment is a result of decades of marginalizing addiction as a social problem rather than treating it as a medical condition. Much of what passes for “treatment” of addiction bears little resemblance to the treatment of other health conditions.
Much of what is offered in addiction “rehabilitation” programs has not been subject to rigorous scientific study and the existing body of evidence demonstrating principles of effective treatment has not been taken to scale or integrated effectively into many of the treatment programs operating nationwide.

Addiction treatment in the U.S. is yet another orphan system in the overall health care system — kind of like the mental health system’s little, sometimes neglected brother. One of the report’s recommendations is to bring the addiction treatment system into the larger mainstream health care system — mainstream it, if you will.
That’s a recommendation I can get on board with. Effective addiction treatment needs to be brought out into the spotlight in order to highlight what research shows actually works and is effective. We’ll highlight some of those findings in the coming months.

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The Curious Industry of Marketing Treatment, Rehab Centers

Everyday, when we open our electronic mailbox, we get our fair share of unsolicited email. Of course, the unsolicited offers have gotten a lot more subtle and duplicitous. A few years ago, dozens of marketeers tried to get us to post badly sourced and designed infographics.
Now they’ve moved on to something that, in my opinion, looks a lot like deception.
In today’s email box, we found an email from “Jeffrey Redd, Project Outreach Director” with an email address of jeff@va.gov.samhsa.net sharing with us “a guide about finding treatment, free of cost.” Wow, really? A new fantastic resource from the folks over at SAMHSA?
But wait, hold on a minute. That email address doesn’t look quite right…

Here’s the, in my opinion, seemingly deceptive email:¹

SAMHSA stands for the Substance Abuse and Mental Health Services Administration — an arm of the U.S. federal government’s Department of Health and Human Services. The official SAMHSA website is at: www.samhsa.gov
SAMHSA.net, on the other hand, is a domain owned by a Search Engine Optimization (SEO) firm, Website Consultants Inc. of North Fort Myers, Florida:

[Click for larger image]

The email address “Jeff” sent from — jeff@va.gov.samhsa.net — is meant to invoke a government association with these three words: SAMHSA, “gov” (which is where all the government domains reside), and “va” which might stand for Veterans Administration (or Virginia). After I spoke with Beachway representatives on Wednesday — but before I spoke to the SEO firm — this domain’s ownership was hidden behind a proxy service.
SEO firms work to improve the search engine rankings of their clients’ websites. SAMHSA.net had a single page of content (since removed, but here’s copy of it) that had been rewritten from SAMHSA.gov’s legitimate content. The title of the deceptive page was “The Substance Abuse and Mental Health Service Administration” and there were no disclaimers to suggest that it was not an official federal government resource.
In this case, the client was a firm called Beachway Therapy Center, located in Delray Beach, Florida. I first spoke with the COO of Beachway, to understand who Jeffrey Redd was, and why he was telling me — unsolicited — about a “white paper” (about how to receive “free” treatment) that resided on Beachway Therapy Center’s domain.
The COO didn’t know anything about it and referred me instead to Stephen Howley, the admissions director of Beachway. During a brief telephone conversation, he also said he didn’t know any Jeffrey Redd, and at first suggested that this was a work of a competitor trying to steal or infringe upon Beachway’s branding.² He also suggested perhaps it was something sent out by his SEO firm, but he thought it unlikely.
Then I asked Mr. Howley for the name of his SEO firm. “Website Consultants Inc.,” he replied.
I pointed out that the exact same firm is responsible for registering the domain name, samhsa.net, and so it was unlikely this email was sent out by a competitor. “I’ll have to have a talk with them,” said Mr. Howley.
When asked if he knew of this apparently deceptive email being sent, Mr. Howley replied, “I can assure you 100% that we had no prior knowledge of this sort of thing.”
We contacted the SEO firm and spoke via phone and emails with Sean Callahan, the president and co-founder of Website Consultants. He also didn’t know who Jeffrey Redd was, so he asked for a copy of the email. After reviewing the email, he pegged the errant email on a link-building firm that he said had leased the domain SAMHSA.net: “They are obviously abusing the domain we leased to them, so we have terminated the agreement effective today.” Mr. Callahan refused to name the link-building firm, citing a non-disclosure agreement.
I understand it’s hard to get your name out there if you’re a treatment or rehab center. It’s even more difficult to appear higher up in search results. But good content gets indexed by Google and Bing, plain and simple — there are no tricks you need to employ in order to get it indexed. Yes, it takes time, and yes, it takes even more time to build up an online reputation for your domain. Seeking ways to circumvent the system or hurry up the process may work (at least temporarily, until the algorithm changes yet again) — but also may bring you unwanted publicity.
Sometimes rehab centers get a bad name because of their aggressive strategies for trying to attract new patients. It’s no wonder.

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