The last week or so has been the hardest time I have had thus far in my 151 days of sobriety. I feel quite anxious, overly sensitive, and self-conscious. Stress does strange things to me. I am not used to caring about anything, so when I go through something stressful, or emotionally trying, it throws me for a loop.
Apparently, these feelings are normal, and the stressors are just everyday life events. This is what regular people feel? Damn. I’ve been reflecting upon what life was like before I discovered drugs and alcohol could temporarily relieve my physical and emotional pain as well as my anxiety, and I’m coming to realize that I was an overly emotional and sensitive kid. Really, that’s what I still am. I only consider myself to be a semi-adult, which is something I’m working on. 

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How do you learn to deal with emotions, with living life again sober when you can't even cope with living? I'm only 24 years old and I've been addicted to one drug or another for the past 10 years and I'm so tired. I can't do it anymore but I'm terrified of living drug-free because I won't be able to shut my emotions off.
How do you learn to deal with emotions, with living life again sober when you can't even cope with living? I'm only 24 years old and I've been addicted to one drug or another for the past 10 years and I'm so tired. I can't do it anymore but I'm terrified of living drug-free because I won't be able to shut my emotions off.

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Heroin needs no marketing. It’s a perfect product that virtually sells itself. Wherever there is heroin it will be bought, no sales pitch necessary. Yet a deadly batch of heroin flowing through Western Massachusetts is being sardonically marketed as “Hollywood”—so pure it has users falling out in a flash. 
Like any brilliant marketing scheme, Hollywood heroin brings to mind an unshakable image: blinding bright bulbs followed by bodies falling toward the concrete embedded, brass stars. The Hollywood batch is responsible for several fatal overdoses since December 30. It’s wrecked towns, broken apart families, and has kept police and first responders on their toes, waiting for the next call. But justice so far has been swift. On Jan. 3, in Springfield, Mass., some 9,000 bags and $20,000 in cash were seized during drug raids.

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“Welcome to the United States of Addiction,” Chris Bell says in the opening of his new thought-provoking and terrifying exposé-documentary. “America is only 5% of the world’s population but we consume 75% of the world’s pharmaceutical drugs.” 
It was Wednesday, January 13, and I was at the Hollywood ArcLight theater for a packed invite-only screening for the LA premiere ofPrescription Thugs, presented by Samuel Goldwyn Films. Bell, who’s known for his 2008 film,Bigger Stronger Fasterwhich examined the pervasive use of anabolic steroids in sports, was now investigating the entire pharmaceutical drug industry: the lies, the money, the abuse. It’s an important film, not just for addicts but for anybody who takes medication…and that’s pretty much everyone.   

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Runners have known it for years: Exercise helps curb the craving for addictive drugs. It’s no different for animals: Rats in cages with running wheels show less interest in amphetamine infusions than rats without exercise options. A recentVanderbilt Universitystudy published in the journal PLoS ONEshowed that heavy marijuana smokers (6 joints per day) with no interest in quitting reported less cannabis use after a modest two-week exercise regimen. In fact, the runner’s high and the cannabis high are more similar than anybody might have previously imagined. Compared to endorphins—the usual explanation for the runner’s high--the painkilling effect produced by the brain’s internal cannabis compounds is much more consistent with the demands of exercise. While high doses of marijuana tend to have a sedating effect, low doses induce activity or hyperactivity. Physical activity may promote cell growth in key areas of the brain involved in addiction, helping to calm the neural whirlwind of withdrawal and craving.

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As with any and all issues, my general responses here do not replace individual support and should not be considered medical management for any individual or family. Any answers here are for informational purposes only. Personal treatment, interventions and case management are between you and your medical care providers.

That said, as a general rule, treatment is best considered as a family issue and not just rehabilitation for the child. Most programs include various aspects of family sessions, family training and psychological education, family support, and peer-to-peer counsel. This might include face-to-face forums, on-line chat and support forums.

Outside of programmatic support, personal support is helpful, including personal therapy, peer support, co-dependency support groups and groups such as NAMI (the National Alliance on Mental Illness), which supports families dealing with the co-occurring disorders of mental illness and substance abuse.

As your family begins its relationship with recovery, it is important to remember that each person and each family navigates recovery differently. The intention of residential treatment is to return positive control back to the client, teach behavioral and coping skills and create positive alternatives for stress management, addictive behaviors, as well as identify and address underlying emotional issues. It is helpful that family members use the time apart for their own healing, learning and recovery. Find restorative time and rest for yourself, carve out time for positive experiences with other family members, and obtain professional support for yourself if you have not already. Engage in your son’s program, learn about addiction, co-occurring disorders and cross addiction, and fight isolation by participating in peer to peer support.

It is hard to predict re-entry needs this early in your son’s recovery but, in general, moving from a residential program back home is a process that will require additional support. Lining up services for yourself and your child in anticipation of his return can provide a system-of-care safety net.

Residential treatment provides structure 24/7; returning to a less structured environment can be a challenge to all. Setting clear ground rules and expectations should be part of your son’s exit from rehab and of your re-entry protocols, and these should inform your dialogue with your child upon his return. Establishing a clear sense of routine and expectation is important. Some families utilize a step-down process where children return into an intensive outpatient program or a sober living environment before their full return back home. Typically, inpatient programs will provide guidance in these transitions.

Re-entry into the family and home environment can be a particularly triggering time so making sure services are in place for yourself, other family members and your son to cushion the stressors of return.


Doreen Maller, MFT, PhD, began her practice in community mental health with a specialty in high-risk children and their families, including numerous families coping with addiction issues. Dr. Maller is the series editor of the three-volume Praeger Handbook of Community Mental Health Practice. See www.doreenmaller.com


Amid Cape Cod’s coastal lighthouses, quaint hamlets and seafood shacks, lives a lost generation. Be it lack of opportunity or simple boredom, white and mostly middle-class twentysomethings—locals of so-called Cape Nod—are blotting out their conscious life with constant shots of heroin. But if you follow the headlines, this phenomenon is happening in towns all over the country. Heroin, it seems, is now as ordinary and American as apple pie. 
Which is why I felt a sense of urgency watching Oscar winner Steven Okazaki’s latest documentary, Heroin: Cape Cod, USA. It is totally wracking, but necessary. At times it felt like watching gruesome surgery through a two-way mirror, or helplessly stumbling upon a brutal car accident. I simultaneously feared and desired to watch the eight millennial participants barbarically wrap white iPhone wires around their wrists, dig for veins, only to nod their supposed best days away in their childhood bedrooms. 

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When I began my life in sobriety, I was ashamed and worried about what the people around me would think.  Eventually, I became comfortable with my sobriety, and in turn I became more open about the fact that I was in recovery.  I found that most, if not all, the people that I knew were supportive of my journey, and some were intrigued.  Those that were intrigued began to ask questions, either for their own struggles, or for the struggles of a "friend".  People would ask about my drug of choice, when or why I decided to seek help, and how did I actually come out of the abyss that is addiction.  I am very open, maybe sometimes too open, about what it was like and what it is like now, and that I recovered in the rooms of Alcoholics Anonymous.
When I tell a person that thinks that they may be struggling with addiction or alcoholism how I got sober, they always seem to be surprised that it was through a 12-step program, rather than by some miracle of science.  I tell of going through detox and then in-patient rehabilitation for months, all the while seeing counselors and case managers and therapists, and of course, going to meetings, obtaining a sponsor, and working the 12 steps.  Some people literally scoff.  "I've tried that, it's not for me."  "I don't think my problem is that bad."  "I just need to figure out how to control it."  "Isn't that a cult?"  "I don't believe in God, that program shoves God down your throat."  
What is baffling to me about these reactions, is the fact that I'm in recovery, and living life as a happy, productive member of society, and the person on the other side of the conversation is actively using or drinking enough to think that they may need help, but they are unwilling to take certain steps to recover.  Initially these responses are hard for me to take, and my first reaction is to say "Then why are you asking?".  I have to remember that at one point in time, I too was unwilling to take direction.
When I went into rehab in August of 2013, I had no idea what was in store for me.  All I knew at the time was that I was in desperate need of a life change, and my drinking and using were out of control.  Had I been told I was going to have to put forth an immense amount of work not just to get sober, but to stay sober, I probably wouldn't have made the most important step of my life.  Even after detox and rehab, I was still unwilling to let go of certain ideas, and 15 months after I worked so hard to kick all my habits, I relapsed.
Unfortunately, taking the path of least resistance is no longer suitable for me.  As far back as I can remember, I did the bare minimum to get by in life.  I did not want to work, and somehow I felt entitled, like the world owed me something.  It was extremely hard, and it took a long time, years actually, for me to finally realize that my way does not work, and it may be time for me to take suggestion from others that have been more successful in their sobriety than I have been in my own.
Taking suggestion is hard.  I know for me, I just want to do what I want to do, and I could be content in my own bubble, running on self-will.  When I finally started listening instead of just hearing, my mind opened to many new ideas.  I have to practice contrary action every day, other wise I'll walk down the wrong path again and again.  It's a hard pill to swallow, realizing your way is the wrong way, but once you accept the fact that you don't know best, life becomes so simple
Being of service and helping others is one of the primary purposes of the program in which I found salvation.  Helping those that are struggling in a way that I was struggling a very short time ago keeps me sober today.  I still have problems with control, and just want those that ask for help to do exactly what I suggest they do, and that is a defect of my character that I will have to work on for a long time to come.  If you are struggling with addiction or alcoholism, reach out and ask for help.  No one can tell you what will work for you, but the key to success is just being willing to be willing.
If you or someone you love are struggling with addiction visit www.abetterliferecovery.com


   Addiction is a selfish disease. Addiction is indiscriminate in its victims. Like a tidal wave it appears, often without warning or provocation, and destroys everything in its path, leaving its victims bewildered and never quite the same. This indiscriminate disease is also a selfish one. Important for us to remember as it is, the fact that ‘addiction is selfish’ is not as easy thing for anyone to accept. It may not be even be obvious, but it is true. It affects not only the user, but those around us. The selfishness of this disease leaves us incapable of caring for others while we are also incapable of caring for ourselves, or even being cared for at all.


   The Oxford Dictionaries defines the word ‘selfish’ as follows:

   “: lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.”


   Webster’s Dictionary defines the word ‘selfish’ in another way:

   “: having or showing concern only for yourself and not the needs of other people.”

   We put our addiction above all else. We may take care of our personal obligations, but these obligations are only fulfilled after our primary goal has been reached. Ironically, addicts have very few goals, and often, just one: to use. Before we can do anything else, we must use. Using takes up all of our time. We may need to use in order to feel ‘normal’ enough to complete our obligations. We may need to meet up with someone to whom we owe money. We may need to work an extra shift to make up for money we spent. We may be sick, and waiting for relief, and therefore we are late for our obligations. Before we are concerned with anything else, we handle our desire and our need to use. This is the way addiction works. However it presents itself, addiction comes first. For many of us, it has taken up many precious moments of our lives.
   Something takes us away from our families, our friends, our jobs, our schools, our entire lives. Something requires our time and attention. Something takes away our free time. We become unavailable to the people who love us, the people who need us. This is selfish. The irony of the selfishness of addiction is that we are not concerned with ourselves; we are concerned with feeding our need. In sobriety, I take care of myself far more than I ever did when I was using. Ironically, I am a far less selfish person. This is the irony of the selfishness of addiction. When using, I selfishly focused on my own desire and need: the desire, and the need, to use. Even when I didn’t want to use, I had to use, and I took care of that before anything else. Before I looked in the mirror, before I took care of my own real basic needs: food, shelter, income, love; before I took care of myself, I took care of my addiction. Those who love me could not understand how I could be so selfish, and I did not understand how they couldn’t see that I was the farthest thing from my mind. It was the drug, only the drug, always the drug. That was my only concern. I had no hobbies, I had no free time; my hobby was using, and my free time was spent the same.
    While using, we may not give our attention to friends, loved ones, a job, school, or other venues. We are busy caring for our own wants and needs: using. When we are addicted, using is our only true want or need. We need to pay our rent. We need a new coat for winter. We need food in the pantry. We need to spend time with our loved ones. We need to clean our house. We need to bathe, do laundry, feed ourselves. But none of this is taken care of until we get our fix, and in this way, we are selfish. Those who love us want us to be ourselves, be the person they know. Those who love us want us around and want us to be the person they love, but addiction robs us of everything, especially of ourselves.
    For the addict who has found a new way to live, rebuilding relationships is a difficult task. Many who love us feel we have not been present in their lives for so long, other than when we have caused pain and disappointment. Some may have resentments and feel bitter towards us for our selfishness. Recovery has provided an opportunity for many addicts to care for themselves in ways we have never known. When we care for ourselves, we are more capable of caring for others. The watermark of addiction may still be visible in our lives. It is the point where the tidal wave crested, and then flowed back to sea. Let this be a reminder of where we never have to go again, and how things never have to be.


We still don’t get it right when it comes to understanding addiction. The most recent example of our failure to appreciate what makes addictive behavior so compelling is the burgeoning widespread addiction to the synthetic opiate oxycodone—with all of its tragic consequences. We keep reacting as if the problem is the potency of the drug itself that leads to the escalation of use and, unfortunately, sometimes progression to the more deadly intravenous use of heroin. The examples that are most frequently encountered are the instances where oxycodone was initially prescribed for some medical or surgical problem, but then the person becomes “hooked.” As the psychoanalyst Sandor Rado instructed at the turn of the 20th century, it is not the drug but the urge to use it that causes addiction. Similarly, Norman Zinberg pointed out that it is the drug interacting with the person and their surroundings—i.e., drug, set, and setting—that leads to addiction. I offer another example that has recently caught my attention as yet another mischaracterization and misunderstanding of what addiction is about. This one has to do with recent clinician warnings that addicted individuals on the street and in correctional settings are seeking out Seroquel, a powerful antipsychotic drug, to “get high.” This is just one more pejorative and stigmatizing misinterpretation of addiction.

The generic name for Seroquel is quetiapine, thus the use of the street term “Q Ball.” While the street name of the drug draws a parallel to street use of “speedball” injections—an intravenous admixture of opiate and cocaine—the presumed intentions behind the misuse of the two drugs couldn’t be more different. You don’t get “high” on Seroquel—you get tranquilized, you get relief from something so disturbing that it makes you go to great lengths to shut it off.

As my colleagues and I have written in the past, I believe that substance addiction “functions as a compensatory means to modulate distressful affects and self-soothe from unmanageable psychological states” and that substance misusers are unsuccessful in managing negative emotional states on their own, without the use of substances. Instead, “substance abusers use drug actions, both physiological and psychological effects, to regulate distressful emotions and achieve an emotional stability.” I view substance addiction and misuse as an interplay between the properties of the drug of choice and the “inner states of psychological suffering and personality organization” of the user.

For example, opiates (e.g., heroin, codeine, and oxycodone), which are used medically for pain management, may similarly be used by persons who have difficulty managing their rage and aggression, which I posit are “often linked back to earlier traumatic exposure to violence and aggression.” In this manner, “opiate abuse functions as a temporarily adaptive response that mutes and attenuates the rage and aggression.”

As another example, the drug effects of cocaine use may include elevated mood, improved confidence and an enhancement of feelings of self-esteem. There is evidence to suggest that “low-energy individuals use cocaine because they do not possess an adequate degree of psychological capacity to relieve themselves from the feelings of boredom, emptiness, and fatigue state, whereas high-energy individuals use cocaine because of their magnified need for elated sensations. Cocaine users' need to regulate inner emptiness, boredom, and depressive states or to maintain restlessness draw them to the powerful, energizing effects of cocaine.”

Finally, alcohol misusers frequently present with “rigidly overcontained, constricted emotions. To avoid distressful affects, emotions are isolated and “cut off” from abusers’ awareness through the use of rigid defenses, leaving the feelings of emptiness and isolation.” Alcohol, a depressant with sedating and relaxing qualities, softens these rigid defenses and provides relief from these constricted emotions.

So I argue that simplified explanations for the seductiveness of drugs are insufficient explanations for the development of addiction, whether it is alcohol, cocaine, marijuana, oxycodone or Seroquel. The use, misuse and sometimes dependence on these substances are driven by a meaningful and purposeful connection between the inner state of the individual and the effects of the person’s drug of choice. As psychoanalystDebra Rothschild has pointed out, in addiction theory and practice “the object of study should be the individual rather than the substance." Here, in what follows I offer a perspective on some of the psychodynamic determinants that make addiction so compelling.

With respect to Seroquel, it could be argued that since it is sedating, individuals are drawn to it to help them sleep. More often, what is not sufficiently appreciated in these cases is why individuals seek these drugs out so persistently. Indeed, if it is for sleep, we do not often enough ask what keeps people from sleep. And in the case of inmates who seek it out for reasons beyond sleep, what could its appeal be? Is it possible that Seroquel does for them what is does for the more seriously mentally ill?

The term “sedative” does not do justice to the effects of medications like Seroquel. Medications in this category are powerful agents to quell states of agitation, intense fear and uncontrollable rage and violent feelings. Recent reports, for example, indicate that quetiapine is effective in treating patients who suffer with borderline personality, a condition in which the aforementioned intense painful emotions predominate. Opiate pain medications have similar actions. As a returning combat veteran suffering with all the violent feelings of rage and anger associated with his PTSD put it, “I don’t use the heroin to get high; I use it to feel normal.” These feeling states can keep us awake and tossing, or can cause a person such discomfort as to want to “zone out.” Pharmaceuticals such as Seroquel are powerful calming agents, which in good part explains their appeal. Yet unlike addictive drugs, Seroquel does not cause tolerance (the need to use more to get the same effect) or dramatic withdrawal symptoms when the drug is discontinued.

Despite the fact that individuals who experience extreme physical trauma (e.g., painful burn conditions), and are treated with opiate pain killers, in the largest majority of instances do not become addicted. What more likely happens is a vulnerable person discovers that such drugs counter more than the feelings of physical pain. Rather, the drugs grab ahold of susceptible individuals because knowingly or unknowingly they suffer with co-existing psychiatric conditions and painful psychological feelings and states. A recovering alcoholic physician, a reserved and reticent man, described himself as a “born-again” isolationist, and in exquisite and colorful language, described in group therapy the preparation of a gin martini—the scent of the bitters, the crackling of the ice, etc. Then he exuberantly exclaimed, “I could feel free, be one of the guys, I could join the human race!”

Addictive drugs, as powerfully compelling as they can be, are not universally appealing. Whether in non-medical experimentation or legitimate medical use, most individuals exposed to these drugs do not become addicted. We still tend to explain the appeal of addictive drugs on the basis of reward and pleasure (“the high”) that can be obtained from these drugs. Such explanations derive from old and new theories about addiction. Freud and his early followers emphasized pleasure drives (and to some extent destructive drives), and modern neuroscientists, examining where the drugs act in the brain explain that addictive drugs “hijack” the pleasure and reward centers of the brain.

Then if it is not pleasure or physical pain that causes addiction, why are some of us more vulnerable than others to addiction? My colleagues and I at Cambridge Hospital have collectively spent more than six decades trying to explore, understand, and explain the powerfully compelling nature of addiction. Beyond biological addictive mechanisms of tolerance and withdrawal, and genetic predispositions, we have had enough extensive clinical evidence backed by empirical studies to conclude that addictive disorders are related to the powerful effects addictive drugs have on a range of painful feeling states, thus giving them their appeal. For example, there is data indicating that there is a far disproportionately high co-occurrence of addictive disorders in conditions such as post-traumatic stress disorder, bipolar disorder, attention deficit disorder, and schizophrenia, conditions which have unimaginable emotional pain associated with them, which we understand makes such people self-medicate. And one need not suffer with a painful psychiatric condition, however, to find addictive drugs appealing. Those who endure excessive painful or intolerable emotions are also more likely to find inordinate relief and comfort in addictive drugs. If there is “reward” associated with addictions, it is less the reward of pleasure, but more the reward of relief from intense psychological suffering.

Dr. Khantzian is Professor of Psychiatry, part time, Harvard Medical School in Boston, and President and Chairman, Board of Directors, Physician Health Services of the Massachusetts Medical Society in Waltham, Mass. He is in private practice and specializes in addiction psychiatry.

For original article visit: https://www.thefix.com/why-some-people-more-vulnerable-addiction