“The situation is somewhat similar to tobacco a few decades ago,” with drinking deeply rooted in social habits and promoted in advertising and movies, says Paolo Boffetta, director of the Institute for Translational Epidemiology at Mount Sinai School of Medicine in New York.
The whole article is worth a read.
The New York Times’ Nick Kristof has a good new column about the biochemical nature of addiction, based on its influence on dopamine and other brain chemicals. He’s writing about DavidLinden’s new book, “The Compass of Pleasure,” which I am now reading.
Kristof notes that things like altruism and acts of charity, not just chemical addictions or “process” compulsions/addictions, can light up the pleasure centers of our brain, as can things like exercise. (And yes, the research that Linden notes says that “processes,” i.e., gambling, overeating, and extreme sexual behavior, can become addictive in the same way as chemicals.
More on this below the fold:
I’ve written before about food as potentially addictive, so let me quote from Kristof’s column:
In particular, foods with sugar or fat seem to trigger cravings that then rewire the brain’s pleasure circuitry to amplify that craving.
One study found that rats fed foods like cheesecake and chocolate showed differences in brain circuitry after just 40 days. The impact was that the pleasure centers of their brains were numbed, so they apparently needed to gobble even more cheesecake to generate the same satisfaction. Whether it’s sugar or heroin, the body steadily ratchets up the quantity necessary to provide the same high.
At the same time, Linden notes that past personal histories, environmental backgrounds and more, whether with fatty foods or alcohol and drugs, are part of what’s behind why some users become addicts and others don’t.
Not a lot else that’s new or in-depth in the book, just more confirmation of the biochemical nature and psychological complexity of addiction.
While the popularity of various illegal substances rises and falls, alcohol consistently remains the granddaddy of recreational drugs. New forms of alcoholic drinks began appearing in the 1980s, first with wine coolers and then flavored alcoholic beverages (that’s FAB, for short) and energy drinks. They have gained popularity, especially among youth. Now, just months after the FDA urged the removal of caffeine from alcoholic drinks such as Four Loko, beverage companies are once again shape-shifting their fruity-tasting concoctions and they’re literally bigger than ever: they’ve been supersized. The new packaging, still largely targeting young (and often underage) drinkers, features a 23.5 ounce can with a 12% alcohol content. That’s equivalent to four or five beers (a fact that marketers of the product recently agreed to change Four Loko’s label to reflect). They’re cheap, accessible, and highly potent.
Why is this a concern? The numbers tell the story. 10.7 million underage youth drink alcohol, and about 70% of those youth binge drink, resulting in harmful physical consequences, poor judgment, lower inhibitions, and an abundance of high-risk sexual behaviors. And the concerns extend beyond youth. Excessive consumption of alcohol is a significant health concern for everyone,
Hi xxxxx,
It’s good to ‘see’ you again, even if the circumstances could be happier. I’m encouraged to see that you are doing something about the problem. That’s what stops most people. They suffer, but they don’t do anything. You are doing something, which is infinitely better than doing nothing, but it would seem that you are either not doing quite the right thing, or you are not doing enough of it.
You know, people often like to say that the definition of insanity is doing the same thing and expecting different results. I don’t think that is true. I think that is, in fact, the definition of practice. When we practice something, we get good at it. So it’s likely that you are good at quitting, but you may also be getting good at slipping. If I were going to look somewhere, that is where I would look: not so much at the depression itself, and certainly not at the escalation of the drinking when it starts, but more at what immediately precedes the slip. Do you plan? Do you debate with yourself? How long between the decision to drink and the purchase?
If you know these things, and particularly if you have them written down, you can make plans to counteract them. If you have a plan for an action that you will take as soon as your find yourself planning a slip, or a tool (like a previously prepared T-chart) to use in a debate, or a way to prevent impulse purchases (like asking the closest shop not to sell to you), you can prevent them from happening.
Next, I would suggest overkill. This problem keeps dogging you and degrading your quality of life. Time to beat it once and for all. That’s probably worth a lot of time. If you add up the time you spend actually drinking, the time you spend hungover/stressed/spaced out, and the time you spend worrying about your drinking, I bet it adds up. For me, I was looking at more than half of my waking life. If you were to commit to spending half that time working on sobriety (for me that was four hours a day) you’d still come out ahead. And it sounds like you would not be adverse to more activity anyway. Can you travel to a better meeting? Read advanced books on the brain science of what is going on? Volunteer with an organization that helps addicts on the street? Prepare to start a local Lifering meeting when you have six month sobriety? Commit to posting on this mailing list every day? Join the Lifering Forum? Find a SMART meeting? If you can, why not do all of the above? If you can’t, how about most of the above, or a similar number of different things.
I have been watching people both get sober and slip for many years, and one pattern that I notice is that people who go at it hammer and tongs and do, do, DO things, have a much higher success rate than those who do not. People worry about burnout, but I have not seen that be a problem.
After a few months of all-recovery, all-the-time, you’ll be ripe for engineering the rest of your life so as to build a state in which drinking is unlikely, unattractive and untenable. You might start a new career, or take up meditation, or run for office. But the short term goal has to be getting through those first few months.
Yours,
xxxxxx
“The way we explain this, is even though employed individuals have a job, they could be affected psychologically (e.g., fear of losing their job) from an economic downturn, leading them to have more drinking days and driving under the influence episodes as the state-level unemployment rate increases,” French said.
So, if you are sober, even if you have plenty of time being sober, if you have any worries about your job, your career field, etc., the obvious advice is: Be open about your fears, talk to others, be proactive with sobriety support.
Here is news that may be of interest both to older readers and ones with older relatives and friends. It’s from the medpagetoday.com website. The article does assume that alcohol abuse is a “disease,” which some may find off-putting.
WASHINGTON — Medicare will pay for annual screenings for alcohol misuse and depression, the Centers for Medicare and Medicaid Services (CMS) announced.
The new services will be added to other covered preventive services at no additional cost to beneficiaries.
“Preventive services bring relief to Medicare beneficiaries for whom preventive care means early identification of disease and greater opportunity for treatment and recovery,” CMS Administrator Donald Berwick, MD, said in a press release. “It’s just as important for our elderly beneficiaries to enjoy access to preventive services as it is for any American.”
In-office screening for alcohol misuse is covered on an annual basis by a primary care provider. If the screen is positive, Medicare will cover up to four “brief, face-to-face” behavioral counseling sessions per year.
Alcohol misuse is defined as risky and harmful drinking that places individuals at risk for future problems.
Risky or hazardous drinking, according to the United States Preventive Services Task Force is defined as more than seven drinks per week or three drinks per occasion for women and more than 14 drinks per week, or more than four drinks per occasion for men.
Misuse of alcohol is linked to cancer, liver disease, and cardiac disease, as well as mental and emotional problems, and contributes to societal problems such as economic losses from illness and injury, according to CMS.
CMS also issued a separate coverage determination on depression that covers Medicare beneficiaries for annual screenings in primary care settings that have resources to follow-up with appropriate treatment and referrals.
Depression affects one in six people over the age of 65 and carries an economic burden of more than $83 billion, according to CMS.
The new depression rule does not address treatment coverage.
For both alcohol misuse and depression, counseling must be performed by “qualified primary care physicians or other primary care practitioners in a primary care setting,” and not in emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, or hospices.
You can read about the research in an article from the New York Times.
The research does raise the alluring possibility that at some time in the future, the day will come when addiction can be treated primarily as a medical problem.
A LifeRing supporter recently posted to another website a good description of what sets LifeRing apart. Writing to the forum of www.psychcentral.com, a poster identified as Willcat wrote:
In ancient Greek mythology there was a roadside bandit named Procrustes who had a bed in which he forced all travelers to lie. Those who were shorter than the bed, he stretched until their bones cracked; those who were longer, he cut off their feet.
Most alcoholism and addiction programs are like Procrustes and his bed. Everyone has “The Program”: one size fits all. In AA, everyone does the Twelve Steps. In Rational Recovery, everyone does AVRT. In SMART, everyone does REBT. And so on. Each vendor promises that its particular Program is the Answer. In fact, some people are helped by the Steps, some are not, and the same is true of the others. There is no such thing as one Program that works for everybody, and we doubt there will ever be.
LSR is unique in the alcoholism and addiction movement in deliberately not offering a capital-P Program. We have no Program, no panacea, no one-size-fits-all, no cookie cutter, no miracle cure, no magic pill to sell. We reject the whole dichotomy between Program and alcoholic, in which The Program is the active, knowing, healthy protagonist and the alcoholic is the passive, dumb, sick raw material to be stamped and molded into the desired shape. We think that any approach that acts on the alcoholic over time as an outside compulsion, a Program, is doomed to fail with most people most of the time.
No program, including the LSR self-empowerment approach, will work if the person doesn’t have an inner desire to escape from addiction. LSR rests its entire chance of success on the encouragement and rational nurture of that desire.
We hold that each alcoholic or addict needs to construct their own sobriety based on their own experiences and needs. We think each alcoholic not only needs to, but is able to constuct his or her own personal sobriety program, if afforded the support and the tools. The work of puting a program together must be and is done by the newly recovering persons themselves, just as each of us with long-term sobriety has done it for ourselves. We have confidence in the ability of alcoholics and addicts, no matter how serious our history, to pull ourselves together with peer support. We have seen it work. Conversely, we are quite certain that we cannot get and stay sober unless we construct a sobriety program for ourselves. That is why we say that we have no one (big-P) Program; we have as many programs (small p) as we have participants.
Dr. Davis is a great supporter of LifeRing, and his emphasis on choice in recovery meshes particularly well with LifeRing’s individualized personal recovery plans. Sacramento’s Strategies for Change holds ten LifeRing meetings each week and partnered with LifeRing at this year’s Recovery Month celebration at the California State Capitol.
Davis was the keynote speaker at the 2008 LifeRing Congress. (A DVD recording of the keynote address A Quality of Life Perspective is available from the LifeRing Bookstore.)
Davis consistently emphasizes that recovery has to offer the former user more than abstinence and meeting attendance. Improvement in the quality of life, whether through improved economic conditions, education, employment, and social and community connections – to name a few – is essential. In developing his argument, Dr. Davis skewers some of the sacred cows of traditional addiction treatment, including those features of the disease theory of addiction which may reduce individual self-efficacy. View a recent powerpoint presentation on this topic by Dr. Davis: Obstacles to Implementing
Evidence Based Treatment.
If you are attending the CAADAC Conference, please make a point to visit the LifeRing exhibit and to attend Dr. Davis’ presentation!