Wednesday, July 27, 2011

Rehab's Words of Wisdom

Addiction: The disease that lies

Marvin S eppala, M.D., is the chief medical officer of Hazelden, a private not-for-profit alcohol and drug treatment program


I learned of four addiction-related deaths this weekend. Three were people I knew in Portland, Oregon, recovery circles and the fourth was Amy Winehouse.

Tragically one must get used to such news if you spend a lot of time with those who have this disease. Whenever someone with addiction dies, I grieve the lost potential and wonder about the limitations of our ability to address this cunning, baffling and powerful disease.

I am also humbled by my own experience with addiction and recovery, and grateful for the help I received.

It seems nearly impossible to believe that people with addiction would continue to use drugs and alcohol to the point of death, but that is what people with addiction do: They deny both the consequences and the risks of using. As we continue to learn about addiction, we’re understanding more about why addicted people behave the way they do. But that’s little solace for friends and family.

Addiction is a brain disease, and our knowledge of it has expanded significantly, which has informed our treatment programs and altered our perceptions. We know that addiction resides in the limbic system, a subconscious part of our brain that is involved with memory, emotion and reward.

We refer to this area of the brain as the reward center, as it ensures that all rewarding or reinforcing activities, especially those associated with our survival, are prioritized. The reward center makes sure we survive by eating, drinking fluids, having sex (for survival of the species) and maintaining human interactions.

In late stages of addiction we can see how reward-related drives, especially those for survival, are reprioritized when people risk their families, their jobs, even their lives to continue to use drugs and alcohol. The continued use of the drug becomes the most important drive, at a subconscious level and unrecognized by the individual, undermining even life itself.

When a methamphetamine-addicted mother makes the nightly news after neglecting her children for four days while on a meth run, we can’t comprehend how anyone could do such a thing and tend to think she does not love her children. She may have been going out for groceries with the intent to return home and feed her children, but ran into a dealer and started using.

Addiction took over, and she was driven by subconscious forces even though she loves her children as much as I love mine. Her love and her natural instincts to care for and nurture her children were overridden by her own brain, the reward system reprogrammed to seek and use drugs at all costs. Unbeknownst to her, drug use has become the most important thing in her life.

When we witness the incomprehensible behaviors associated with addiction we need to remember these people have a disease, one that alters their brain and their behaviors. We tend to believe we all have free will, so it is difficult to understand how the addicts' perception has been so altered as to drive them to destruction.

We also assume they can make their own decisions, especially when it comes to help for their addiction. In so doing we are expecting the person with a diseased brain to accept the unacceptable, that the continued use of drugs is not providing relief from the problem - it is the problem, and they need to stop that which has become paramount.

They are unable to make such decisions because their brains have been altered to prioritize use of the drugs, even above survival itself.

Relief of psychic pain, the real, unimaginable pain of addiction, is part of the problem. People have many reasons for seeking relief from pain; some pain precedes the addiction, but most pain is the result of the addiction.

The addicted neglect their primary relationships and they may lie, cheat and steal to continue drug use. And they know this at some level, they recognize their uncontrolled behaviors, but they can’t change, they can’t stop.

Hopelessness becomes a way of life. Self-loathing, shame and guilt become the norm as the consequences of continued drug use accumulate.

They use drugs to ease the pain, but the very remedy exacerbates the problem. The answer to their dilemma goes unrecognized due to the neurobiological changes that have occurred in their brains.

The good news is that treatment is effective and specifically designed to help people recognize the problem within. Most people are coerced into treatment for one reason or another; they may be facing legal issues, job loss or divorce.

With good treatment their likelihood for recovery and abstinence is just as good as the minority who seek treatment of their own accord. Unfortunately, less than 10% of those with addiction recognize they have it and seek treatment.

This is the primary reason people don’t seek help. Our largest public health problem goes unrecognized by those with the disease.

Every one of these deaths is tragic. They died of a disease that lies to them. Amy Winehouse had incredible musical talent that enthralled the masses, but she became known as much for her struggle with addiction.

We can safely watch such a tragedy, gawking as we drive by the destruction, insulated from the suffering and unable to help. But addiction is all around us and we need to respond to the rising death toll.

All of us are responsible for learning the truth about addiction, raising awareness and intervening for those who have this disease, knowing they are unlikely to be able to do for themselves.

I came across this tonight, read it several times and said "Huh!" Less than 10% of those addicted to any drug, and I'll focus on alcohol here, recognize that they're alcoholics? Thus intervention is the answer? Maybe from Hazleden's perspective, but my experience has shown intervention to be one of the least effective modes of getting someone into treatment. This guy makes it sound like we have half the population of the country stumbling around drunk and not having a clue that something's wrong. Thus the rest of the country needs to educate themselves to force the alcoholics into treatment centers.

Yeah, that's the ticket. Force them all in... Don't bother with the little details of how you determine a person is a real alcoholic (or not). And while they're in there for 28 days, run them through the 12 steps and show them what AA should really be like. I'll stop before I go on a rant.



  1. Condolences to Amy's family, friends, and fans.

    She died before she should have and that's because she fucked up.

    I don't blame her for saying no no no to rehab.

    I don't blame her for wanting to kill herself.

    I don't know what It's like to be as talented and famous as her.

    She, I think, was forced into rehab.

    That doesn't work.

    But she had a chance and she fucked up because she's dead.

  2. We drink because we want to, because that’s who we really are, we are alcoholic. We love the euphoria in spite of its destructive consequences. We lie to ourselves; we believe those lies and that’s insanity! The same person who really wants to drink can only delay, deny the errge, maybe resist drinking but for so long. We must therefore become different people, someone with an actual interest in a radical new way of thinking. Dr. Young said that the “Ideas, emotions, and attitudes which were once the guiding forces of the lives of these men are suddenly cast to one side, and a completely new set of conceptions and motives begin to dominate them.”

    Clip from a talk given by Bill Wilson to the medical community 1960:

    “We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady -- a far safer term for us to use”

    Alcohol Problems in the United States: Twenty Years of Treatment Perspective By Thomas F. McGovern, William L. White

  3. I like Bill's stance on the misuse of the word disease.

    I don't have an opinion on why an addict does what they do. I ain't one.

    Y'all may drink the first one because you want to. Lie or no lie, I don't drink the first one because I'm in a position of neutrality... safe and protected.

    If I'm going to unravel and drink that first drink... I'm going to have to push aside everything I've experienced in sobriety up to now... and I do that for some ridiculously trivial excuse.

    It may be want for you, but not me.

    Now that you and I both have booze in our system, do we "want" the 2nd one? Do we really choose it?

    Y'all may. I don't. I'm off and runnin' whether I want it or not.

    For me, It's about that sufficient substitute over that perceived instant of bliss.

    I got it. I am recovered. I am "winning"... Charlie fucking Sheen. If you go next Charlie, I'll piss on your grave... no disrespect. It's just that... if I drink and don't give a shit about my well-being, neither does anybody else. 9 million hits on YouTube ain't gonna bring me back from dead.

    For you alkies, you can get and stay sober. If you really need and want to... you might spend less time bashing methods that work for some of us and finding what works for you.

    If your goal is sobriety, it ain't ok to drink... unless you're recovering or something.

  4. Patrick said being forced into rehab doesn't work. I agree. The author's point here is that few alcoholics (addicts, same damn thing for these purposes) realize they have a problem. We call it denial, I think.

    By forcing everybody into rehab, we supposedly make them confront their problem and ergo they will be saved!

    But, and it's a big but, once they're into rehab their chances of success are the same as those who go it alone. Huh? Then why rehab?

    I think the majority of alcoholics out there deny they have a problem, and no one is ever gonna convince them of their error. It's something you have to discover on your own.

    We call it hitting bottom - when the fact that you're powerless over alcohol breaks through your system of denial. Maybe then rehab would be appropriate.

    But, as Colter states, it's only gonna work if you want it.

  5. Hope Colter has his sense of humor on with the "ed" rant.

    I agree that you do have to want it, but to get it, you have to do it.

  6. Good Stuff,
    A lot of the guys who post on this site, are cut from the same alcoholic cloth I am.

    I did not drink because I wanted to. There were numerous occasions that I desperately did not want to drink...yet I did, time and time again. Power of choice...Gone. I stayed in that place until I was almost physically dead. I agree with Patrick that from this place of utter hopelessness, some willingness to follow directions came.

    Maybe early on in my drinking I could choose if I was going to drink. I've always had the phenomena of craving. Once that booze hits my system, it decides when we are done. Thing is, there where some times when it was satisfied with 3 or 4, giving me the illusion I was in charge..Wrong........

  7. “The will is strong, but the flesh is weak.”

    I didn’t want to do the same thing that I wanted to do.

    There's a member in my area that’s fond of saying, "i don't know what my body did to my head to make my head want to kill it so much".

    Oh sure, I drank against my better judgment, I drank when I had decided not to drink, but when the thought/obsession occurred, I lacked the power to resist the erg that was greater then my tiny moral compass. Alone and disconnected from the spirit, I didn't stand a chance against my true instinct dominated self.

    * Selfishness, self centeredness, that we think is the root of our troubles.

    * Lack of power that was our dilemma. We had to find a power by which we could live and it had to be a power greater then ourselves.


  8. Now then, are we (society in general) responsible, as the author says, to educate ourselves on the truth of addiction? Should it be society's responsibility of ensuring that alcoholics are aware of their "disease" and then intervene to get them into treatment?

    The assumption the author makes here is that once the alcoholic is forced into treatment, they'll become aware of the problem; and, treatment programs being as effective as they are, the problem will be solved.

    But again, if treatment programs are as effective as no treatment program, then why do we need the programs? I mean, other than to support the multi-billion dollar treatment industry?

    And if it is society's responsibility, them how do we "raise the awareness" of the alcoholic? I'm pretty certain that Amy knew she had a problem, and we've all talked about the wet houses, so it seems that there's a certain percentage of drunks out there that just don't give a shit. In that case, intervention may call for a little enthusiastic use of cattle prods....

  9. She really could belt out a tune.

    I think she had no place to hide and was expected to do rehab... when she just wanted to get trashed.

    I'm not saying women are lightweights or anything... but the book talks about women on page 33... and how women's bodies were really not designed for the abuses of booze.

    I still don't know the particulars of her death. Anybody?

  10. Thanks for what you have all written here.

    I really get a lot out of this blog.

  11. And the latest rumor? Poor Amy died of alcohol withdrawal, the good old DT's. At least according to Time Magazine. And locally a woman died while in jail for contempt of court. She showed up for traffic court apparently drunk (blew a .21 in court) and was sent to the hoosegow by a pissed off judge.

    Now this woman had "no history of a drinking problem, was a solid citizen etc." Yet she went into a seizure, was hallucinating and, after being examined jail personnel and place in a single cell, she choked to death on her jail ID bracelet.

    So maybe forcing some of these folks into treatment isn't such a bad option after all. At least when they kill themselves they'll know why.

    I suppose this goes back to Bill W's concern. How do you get the message out to those that need it most. He asked that in the 50's and there's still hasn't been an answer. Maybe in a way the treatment centers do some good sometimes along with the harm they cause. They at least expose folks to AA.

  12. By the way, I'd like to hear Jim's thoughts on all this.

  13. Red rover red rover... send Jimmy on over.