Lead researcher Dr. Richard Blondell, professor of family medicine at UB, and colleagues sought to assess the prevalence of prescription drug use among opioid-dependent individuals who were hospitalized for opiate detoxification. Shockingly, more than half of the opioid-addicted patients reported that legal prescription drugs were their first drug of abuse.

The researchers’ study recruited 75 participating patients who were hospitalized for medical management of opioid withdrawal at the Erie County Medical Center in Buffalo. The patients’ opioid use ranged from derivatives of the opium poppy—including heroin, morphine, and codeine—to artificially produced medications such as methadone or fentanyl. The patients were interviewed regarding their drug use history—including patients’ age of first opioid use, preferred types of opioids, routes of administration, how their opioid abuse began, and how their addictions progressed overtime. Researchers also gathered data regarding the patients’ socioeconomic and demographic backgrounds.

In their responses, 31 patients (41%) reported that their addictions began with legal prescription drugs that were legitimately prescribed to them. Another 24 patients (32%) reported that their addictions began with the use of diverted prescription drugs that they either received or confiscated from a friend or family member.

Only 20 of the 75 patients (27%) reported that their opioid addictions began with illicit street drugs. However, an overwhelming 92% of patients (69 patients) admitted to having purchased a type of opioid drug illicitly ‘off the street’ at some point in time. Heroin was the most commonly purchased street drug among the patients, mostly because heroin is less expensive and more effective than prescription medications. As their addictions progressed, 37 patients (49%) reported that heroin was their preferred drug of abuse, and 43 patients (57%) had self-administered drugs intravenously. The patients had a tendency to cite opioids’ physical and emotional pain-relieving effects as the reason for their continued abuse, stating that the drugs made them feel "like a better person" and "normal," or that they "helped take away emotional pain and stress."

The patients’ characteristics revealed other significant similarities. The average age among patients was 32 years, 65% were male, 77% considered themselves as “white,” 74% had a high school diploma or equivalent, and 52% were unemployed. More specifically, those who considered prescription drugs initially used to relieve pain to be the root of their addictions were more likely to be older, female, have a college degree, and orally administered their drugs. About half of the patients (51%) stated that they first began using prescriptions medications to alleviate back pain or pain following surgery or an injury, while the remaining 49% stated that they began using to experiment with the drugs’ narcotic effects based on their own curiosity or social influences. All of the patients believed themselves to be “addicted.”

Alarmingly, when asked whether a doctor had questioned them regarding the presence of a substance abuse problem prior to writing them a prescription, 74% of the participants who responded to the question answered ‘no.’ The researchers advise that prescribing physicians not only should monitor their patients’ medication use, but that they are in the perfect position to identify or prevent prescription drug abuse among patients. Many pain-relieving medications are potent, highly addictive narcotics and have a high tendency to fuel dependency and abuse. All patients should be warned about these drugs’ serious adverse effects before being administered the medications. Furthermore, patients should be counseled on how to properly dispose of unused medications to help avoid misuse or diversion by friends or family members that can attribute to addiction.

The researchers hope their findings will help educate medical professionals and residents alike on how to effectively screen patients for possible cases of addiction, and to perform interventions or recommend treatment to these patients. Opioid misuse can progress rapidly and create serious hazards to health and safety, especially by paving the way to illicit drug use and addiction. Based on their findings, the researchers suggest that compared to individuals who use prescription drugs legally, those who abuse illegally-obtained prescription drugs are at an increased risk of illicit drug use.

The researchers’ study was recently published in the Journal of Addiction Medicine.

Source: HealthDay News, Robert Preidt, Prescription Painkillers Could Be New ‘Gateway’ Drugs, August 27, 2010

While scientists have previously demonstrated an association between childhood maltreatment and problems with alcohol and its consequences (Bensley, Spieker, Van Eenywk & Schoder, 1999), the motivational mechanisms behind the connection have not been identified. In 2010, researchers examined the reasons behind men and women who have a history of childhood maltreatment and also abuse alcohol (Goldstein, Flett & Wekerle, 2010).

The researchers recruited 86 male and 132 female undergraduate students. They were asked about instances of childhood maltreatment using the 28-item Childhood Trauma Questionnaire. They were also assessed for drinking motives, using the 28-item Modified Drinking Motives Questionnaire-Revised. Alcohol consumption and resulting consequences were measured using the Alcohol Use Disorders Identification Test.

The researchers built models to determine which drinking motives mediated the effect of childhood maltreatment on alcohol problems. Separate models were built for men and women.

The results showed that about half of the male students and about a quarter of the female students were participating in binge drinking on a monthly basis or more. 31 percent of the participants reported a history of abuse and 30 percent of the participants reported a history of neglect. There was a significant association found between abuse or neglect and having alcohol problems.

When it came to male students, the association between maltreatment and alcohol problems was mediated by a motive “to feel good and get happy.” For women, the mediator was the desire to cope with depression and anxiety.

The study’s results are limited by the use of a student-based sample. The results may not be applicable to other populations. Given the prevalence of alcohol-based social activity in college, the behaviors of the participants may be due to other factors than examined. In addition, the study was not designed to determine causality.

Further research is necessary to determine a causal relationship between maltreatment in childhood and drinking in adulthood. A longitudinal study would be more effective at establishing the connection between these two factors. In addition, a larger sample would be effective at determining whether the results were affected by the use of college students as subjects.
 

Treatment Facility Needs to be Properly Staffed

Not every addiction treatment facility is equipped to handle addiction and co-occurring disorders or behavioral conditions (also called dual diagnosis). They often say they do in their ads and marketing material, but saying they treat dual diagnosis and actually being staffed with the right clinicians to handle psychiatric disorders are two different things.
Without psychiatrists on location at regular intervals throughout the week who are able to assess clients and make clinical recommendations for the appropriate treatment of underlying diagnoses, rehab will not be successful. Be sure any addiction treatment facility you are considering is able to meet the needs of your loved one with addiction and a co-occurring psychiatric disorder, possibly with past trauma as well.

Ask questions to find out exactly how the treatment facility handles dual diagnosis clients. What exactly do they do to treat these individuals who also have addiction? Do not just settle for a treatment facility that looks good. Check their success ratio with patients who have been treated there. Make sure that the treatment facility is properly accredited, that all licenses and credentials for the facility and staff are in order.

Dual Diagnosis Requires Concurrent Treatment

Why not just treat the addiction first and worry about the mental health or other issues later? Unfortunately, that used to be the approach utilized at many treatment facilities. Not much was known about how to effectively treat substance abuse and mental health disorders simultaneously. Now, however, research has shown that patients who undergo concurrent treatment for addiction and mental health issues stand a much better chance at being able to achieve and sustain abstinence.

Effective treatment for addiction requires that the patient have a thorough understanding of the disease of addiction, learn about and understand risk factors for relapse, and become familiar with and practice coping strategies and techniques to help them once they complete treatment and rejoin society.

Not only do the co-occurring issues need to be addressed with effective treatment during rehab, they also require follow-up and monitoring in aftercare or continuing care upon completion of treatment. Some patients with dual diagnosis transition from active treatment to a therapeutic community or to other transition living arrangements until they are better equipped to handle the stresses of daily living on their own or return to their families.

Trauma Recovery

Individuals who have and addiction and also suffered past trauma require an integrative therapeutic program that helps them self-heal and reduce the possibility of relapse.

One evidence-based therapy that has been proven to work is eye movement desensitization reprocessing (EMDR). This innovative method of psychotherapy involves eye movement and bilateral stimulation to desensitize and reprocess the patient’s traumatic memories. Since overwhelming emotions can quickly derail recovery and result in relapse, integrated and comprehensive treatment of the past trauma and the addition are necessary to give the patient the best opportunity for recovery.

EMDR works where traditional talk therapy may not, for patients with multiple diagnoses and complex issues. Talk therapy uses methods that work on the left side of the brain, whereas trauma inhabits the brain’s right side. Using only talk therapy, patients remain stuck in past trauma. EMDR is a method that treats both the left and right sides of the brain. Although originally designed to treat traumatic memories, EMDR has been found to effectively treat PTSD, panic disorders, anxiety, and other complaints that follow distressing or overwhelming events. The success rate of EMDR is nothing short of phenomenal. Several studies report success rates of 77 to 90 percent remission in single trauma victims with as few as five hours of treatment.

Serene, Supportive Environment is Key

When your loved one has gone through a great deal of past trauma, in addition to addiction of one form or another (possibly even multiple addictions), and is also grappling with depression, anxiety, and an overall inability to properly function in the world, he or she needs the highest standards of professional care. It also helps to have serene surroundings and a supportive environment to facilitate the healing process.

With 24-hour monitoring and trained professionals always available, any issue that comes up can be addressed quickly and comprehensively. When necessary, additional specialists can be called on-site to delve more deeply into a particular area of their expertise. These may include prominent guest lecturers who may conduct group learning exercises or motivational programs – even therapeutic leisure or recreational activities.

Think of the residential treatment facility as an idyllic island oasis that exists apart from, yet connected to the world, and that is wholly self-sufficient. Everything your loved one requires is available in the treatment facility all during the treatment program that’s been tailored to meet his or her unique needs.

Here your loved one will receive regular re-assessment and adjustment of therapeutic modalities, ongoing medication monitoring, counseling, and medical treatment as required.

Holistic Therapies Aid in Relaxation

Many individuals with anxiety, depression, or other psychiatric disorder benefit greatly from holistic therapies available in residential treatment facilities. These include yoga, meditation, acupuncture, massage, equine therapy, and nutritional counseling.

These holistic therapies, integrated seamlessly with other treatment modalities, help patients to reduce and relieve stress and anger, decrease anxiety, depression, agitation and cravings, as well as increase trust, improve self-esteem, and help balance the mind-body-spirit connection.

Bottom line: If your loved one has depression/anxiety/past trauma, look for a treatment facility that specializes in treating dual diagnosis or co-occurring disorders, along with substance abuse. Thoroughly check it out so that you are satisfied they can meet the unique needs of your loved one. In the end, rehab is much more than just getting clean and walking out the door to rejoin society. It’s also about preparing the individual and providing effective tools to use to embrace and thrive in recovery.

The study, led by Rita Z. Goldstein, a psychologist at the US Department of Energy’s Brookhaven National Laboratory, used brain scans to find out whether methylphenidate (Ritalin) could positively effect brain function and cognitive performance in cocaine addicts. Previous studies have shown than methylphenidate helps decrease risk-taking behaviors and impulsivity among people with ADHD, some forms of dementia, and some types of brain injury.

Goldstein and colleagues performed brain scans on 13 cocaine addicts and 14 non-addicts. After being given a low dose of methylphenidate or a placebo, both groups were asked to perform a cognitive task, which involved pushing a button to identify the color of a printed word. Some words were related to drug use and others were neutral. Correct answers were awarded with money.

The researchers found that cocaine addicts who were given methylphenidate had improved brain function and were less likely to press the button incorrectly or prematurely, which is a measure of impulsivity, than addicts who were given a placebo. Addicts who were given a placebo showed reduced function in the prefrontal cortex regions that help regulate emotion, cognition, and stimuli response. Previous research has found that these areas of the prefrontal cortex are impaired in cocaine addicts.

The researchers also found that the greater the improvement in accuracy with methylphenidate, the greater the activity in the prefrontal cortex areas, showing that the improvements in brain function were directly related to the improvements in cognitive performance.

Goldstein noted that more research needs to be done, but that their results suggest that methylphenidate could help people who are recovering from drug addiction through enhanced prefrontal cortex function and decreased impulsivity.

Source: Science Daily, Ritalin Improves Brain Function, Task Performance in Cocaine Abusers, Study Finds, September 7, 2010

To better understand this phenomenon, a new Geisinger study took a closer look and found that four common risk factors often exist in patients with a significantly higher risk of addiction. When a history of severe drug dependence and drug abuse exist, the risk is compounded even further.

In examining individuals dealing with chronic pain, the Geisinger study identified common risk factors, including age; a history of drug abuse; a history of depression; and the use of psychiatric medications. Among this group of patients, statistics show that painkiller addictions are as high as one in four, suggesting such individuals are more likely to become addicted to painkillers.

It is because of such findings that researchers recommend patients in chronic pain be assessed for these risk factors before painkillers are prescribed as part of their treatment. With the knowledge of the existence of these risk factors, doctors are better able to treat patients’ pain without creating an additional problem of addiction.

To complete this study, Geisinger investigators evaluated data on patients with back pain and other related orthopedic conditions who had been prescribed painkillers for more than 90 days. This evaluation included interviews with 705 of these patients who were willing to supply their DNA for study.

Researchers focused on a gene located on chromosome 15 that has been implicated in dependencies on alcohol, cocaine and nicotine in past studies. The associations of this locus with opioid dependence is unknown and therefore worth studying to better understand the association and risk factors doctors can easily identify to avoid contributing to the development of an addiction.

Family histories can also be evaluated to determine risk in patients with chronic pain. In fact, one study into this association examined 861 identical twin pairs and 653 fraternal twin pairs. An addiction present among an identical twin heightened the risk for the other twin. When the twins were not identical, the risk reduced, suggesting that 50-60 percent of addiction is due to genetic factors.

It is important to note that while genetics can play a role in whether or not an individual develops an addiction, there is no one addiction gene that can be inherited at birth. Instead, there are numerous genes that play a role in addiction and if these genes are found in an individual with the other risk factors mentioned in the Geisinger study, an individual could be at even greater risk.

Research continues to examine these areas of addiction to better understand why some people fall victim while others are never touched by the disease. As new developments in research continue to emerge, doctors are becoming better equipped at helping patients to avoid addiction when all they really need is relief.
 

The answer is yes to both questions. But it’s a little more complicated than that. Isn’t it always? Don’t worry. There’s nothing here that you can’t do. It’s more a matter of wanting to and doing it.

Recognize the Emotion

When you despise yourself, hate what you’ve done in your past when you were strung out on drugs, spent your days in an alcoholic stupor, gambled away the family finances, ignored your loved ones while you immersed yourself in work, or engaged in multiple sexual affairs, it’s a lot to take in. Your first impulse is to bury it deep, squash it down so far that it will never surface.

Your first impulse is wrong. The fact is that you can’t keep self-loathing buried for long. It will always surface, and it will do so in ways that you not only can’t predict, but you’ll feel helpless to counter. Worse yet, extreme self-loathing can precipitate a relapse. So ignoring the emotion is decidedly not the wise thing to do.

Think of recognizing self-loathing as opening up the windows and letting the fresh air in. What you’re doing, in a manner of speaking, is recognizing the despicable nature of the acts, thoughts, and words from your past that creep up unannounced and waylay your current activities, plans, how you feel and/or interact with others – just as you’d recognize stale air from a cooped-up house and do something to freshen it up. You have to recognize these powerful emotions and then give them the boot. They won’t stay once you’ve recognized and acknowledged that they are here now, but they’re just remnants from the past. They have no basis in the present. They don’t belong in the new you in recovery.

But it Hurts

No feeling of self-loathing would be worth its trouble if it was just a fleeting negative thought, would it? So saying it hurts is one of your first clues, if you really need any, that this is self-loathing come knocking at your present. Clamoring for attention, self-loathing seeks to distract you from your recovery plan, your daily schedule, to knock you off your game, to sidetrack your intentions.

For many, it does a good job and accomplishes its nefarious goal. When feelings of self-loathing hurt too much, you start to feel worthless, powerless, and helpless. Granted the bad actions or words or thoughts you had in the past were just that. There’s no denying it, and acknowledging what you did, said, or thought is part of the road to recovery. And we all know how painful overcoming addiction can be at times. So, too, is the path to recovery. But as a common saying goes: “No pain, no gain.” A little hurt (okay, sometimes a lot of hurt) is necessary as you gain the strength and confidence to move forward in your recovery.

You can also look at feelings of self-loathing another way. The sting you feel is a temporary reminder that you still have some things to work on. This is true today and it will be true tomorrow as well. That’s because you never know when the painful reminder of something from your past will pop up. It could be next month, next year, or 10 years from now. Likely as not, there’ll be intermittent barbs of self-loathing. Understand this, and work on dealing with these negative emotions when they occur.

Here’s another picture that may help. Think of the cartoon devil poking at the unsuspecting person while the haloed angel seeks to calm. The person makes the choice between the bad and the good in this instance – and in recovery. Sure it hurts when the devil (self-loathing) pricks you, but it feels better when you listen to your angel (your new way of looking at you in recovery). You make the choice: stick with your self-loathing, or get on with your recovery.

Make a List

After you recognize self-loathing as the burbling up of negatives about your past, and feel the pain of its sting, what should you do next to get on with your recovery? It may help to write it all down. Yes, make a list. And you should be quite familiar with list-making assignments from your time in treatment. This list, however, is strictly about the kinds of negative thoughts you have that trigger self-loathing.

You might separate it into categories of people, places, and things, or thoughts, words, and actions. Do whatever works best for you, whatever makes it easier for you to categorize what’s coming up in your thoughts and making you feel self-hatred.

For example, you might have a recurring thought about the money you stole from your employer to finance your drug or gambling habit. Not only are you constantly worried about being found out – if you haven’t been already – but you secretly harbor a lot of anger and hatred toward yourself for stooping so low. It really doesn’t matter if you rationalized to yourself that your boss was a thoughtless taskmaster or the company would never miss it. That wasn’t you talking, it was your addiction. So, back to your list: put “stole money from employer” on your list as one of the items.

Another example of what you might put on your list is the painful reminder that you lost your family due to your infidelity and drinking. Put “lost spouse and children due to cheating and alcohol.”

Other examples: ruined friend’s reputation, was violent and abusive to my children, killed or seriously injured someone as a result of drunk driving, squandered my children’s college fund to finance my addiction, and so on.

Take time doing your list. You may not think of everything in one sitting, so be prepared to add to the list whenever you find yourself dwelling on some particularly nasty memory of what you did, said, or thought in the past when you were in the throes of addiction.

All of this will add up. You may be overwhelmed by what you see on your growing list. Don’t let it rattle you. Remember that these actions, words, and thoughts occurred in the past. They are not in the present. They can’t hurt you if you don’t let them fester, if you take concrete action – like making this list – to do something to move past them.

Figure Out How to Make Amends

Self-loathing stands in the way of self-forgiveness. You need to get past the trap of self-loathing long before you can begin to forgive yourself for your past. One way to do this is to make amends wherever you can and when it will not cause harm to others.

But figuring out how to make amends is not always easy to do. How can you make amends, for example, for a person you killed as a result of your drunk driving? What if the person you stole from, or the spouse you cheated on, is no longer living? What if the company you embezzled from is now bankrupt? What if your family was so hurt by your actions that to try to see them again to make amends would cause incredible pain?

The strategies and techniques on how to make amends are something that you will learn through your participation in 12-step groups. Suffice to say, making amends is one of the 12 steps, and in order for you to be successful in your recovery, you need to actively work the steps. Your sponsor and fellow 12-step group members can assist you with this particular step, along with all 11 others. They do this in private conversation, readings, lectures, group discussion, and through sharing of personal stories. What worked for one person may work for you or may spark an idea how you can modify the tip to better fit your own circumstance.

Once you figure out how to make amends, write it down on your list of items that trigger self-loathing. While making amends may be included as an action item in your recovery plan, it’s helpful here because it shows that you are putting what you learned into action to give the boot to specific self-loathing emotions.

And, after you’ve made your amends, if applicable, to a particular item on your list, cross it out with a big green X. Use green because it indicates growth, as opposed to red which symbolizes a trouble spot or problem. If what you need to do is an ongoing thing, you may wish to circle the item in yellow.

These are just suggestions, of course, and you don’t need to do them at all. But it may prove helpful to see on paper (or in the computer, if you decide to prepare your list this way) what you’re dealing with in the way of self-loathing emotions, and what you’ve identified as how to make amends, or move past them.

Needless to say, this list is probably best kept to yourself. Or you may wish to share some of it with your sponsor. But no one else really needs to know the specifics of everything that’s on your list. If you do decide to talk about it, do so only with the intention of either a) getting support or encouragement from your 12-step group members or b) helping another 12-step member with tips and techniques that have proven beneficial to you in getting past the trap of self-loathing.

How to Talk with Your Spouse

No, this isn’t a primer in specific words to say to your spouse or just how to go about discussion the issue of self-loathing. What it is, however, is a recommendation that you begin to have an open and ongoing dialogue with your spouse or partner about what’s going on with you, what’s bothering you, what may be holding you back. Why do this? Isn’t it enough that you went through treatment for your addiction and are now back home getting acclimated to your new life in sobriety? Actually, it’s because you’re getting acclimated again that you need the ongoing support and encouragement of your chief ally – your spouse – as you tackle each day’s challenges and opportunities.

You already know the consequences of burying your emotions. They only come back to bite you – with a vengeance.
Keeping mum about your struggle to deal with self-loathing may send a signal to your spouse that you’re hiding something or are turning away or don’t want to share some aspect of your life with him or her. Above all, you don’t want to alienate the person who may be the most important in your life at this time.

Just as you’d make an appointment to have any important discussion at work, or to see the doctor, or have your car’s oil changed, it’s vital that you don’t just spring such a discussion on your spouse or partner. Arrange for a time when the two of you won’t be disturbed, or one or both of you isn’t involved in getting the kids off to school or getting ready for work or church or to go out to do errands. Whether it’s the morning, an afternoon on the weekend, or at night after dinner (but well before bedtime so you don’t have unpleasant thoughts before your retire), make it a time that’s mutually agreeable.
If you prepare your spouse or partner for the idea that you want to keep him or her informed and part of your recovery plan, it will likely be met with a positive reaction. That way, whenever you want or need to discuss something about your recovery, it’s not seen as a negative. In fact, it’s anything but that. By sharing and being open with what you’re doing to remain in sobriety, you’re giving a gift to your spouse. You’re letting him or her know that their opinion and support is valued and necessary, that it’s an expression of love that the two of you share.

Will Self-Loathing Ever Completely Go Away?

The good news is that self-loathing is primarily concentrated in the early stages of recovery. This is when you’re still fresh from treatment and haven’t yet become practiced in the strategies and techniques you learned from your therapists and in groups. You’re still reeling from the sudden freedom – no more constant monitoring, you can come and go pretty much as you please, no one’s saying it’s time for group or meds or the urine test. But with that freedom comes the gnawing (at first) anxiety that you might not make the right decision, or that you don’t know how to combat cravings and urges, or deal with the feelings of self-loathing that wash over you in waves.

After the first few days and weeks of recovery, while you’re setting your daily schedules, attending 12-step meetings, going to see your therapist or counselor, gradually feeling more self-confident, you’ll probably find yourself greeting each passing day with a little more zest. You will make plans for activities that you look forward to doing. There’ll be the recognitions you get from your 12-step group for your first 30 days of sobriety, and then your 60- and 90-day awards, and then your one-year anniversary.

Over time, self-loathing thoughts will gradually diminish. You may think they’ll completely disappear, but that’s not realistic. As previously mentioned, you never know when some reminder of your past may trigger a bout of self-hatred. But with your, by now, well-established ways of dealing with unwelcome thoughts, self-loathing won’t ever hold the power over you that it once did – so long ago in early recovery.

When you are able to recognize the fleeting thought as a self-destructive reminder about the past, you’re firmly into successful recovery. Remind yourself, silently or on paper or talking to yourself in the mirror, that you are living today in sobriety, healthy and happy and fully committed to being a loving spouse, parent, employee, and friend and to doing good deeds for others without expectation of reward.

As a matter of fact, when you live your life as an expression of love – both for yourself and for others – you could say that that’s really all that anyone could ever ask of themselves in recovery. When you love yourself, you do what’s right and good to keep healthy and productive and sober and free. When you love others, you are always doing and saying things that will make their lives happier, easier, and healthier.

So, final thought: Stop thinking about despicable me and get on with taking steps to get past the trap of self-loathing.
It’s easier than you think. And, yes, you can do it.

The messenger ribonucleic acid molecule, or mRNA molecule, is responsible for producing proteins that help manage the body’s circadian rhythmicity, or daily biological rhythms. According to the study—published in an August online issue of Alcoholism: Clinical & Experimental Research—chronic alcohol use has been linked to disruption of the circadian clock genes expression, causing damage to the body’s circadian rhythm. This lack of gene production, as well as its lower restoration rate after being damaged, may explain why many alcoholics experience chronic physiological conditions, such as poor mental health, impaired sleep cycles, or even cancer.

In their study, lead researcher Ming-Chyi Huang and team evaluated the mRNA levels in 22 diagnosed alcohol-dependent (AD) male adults who were undergoing alcohol withdrawal treatment. The 22 AD patients were further divided into two subgroups—those considered having the most severe form of alcohol withdrawal syndrome, delirium tremens (DT), and those who did not exhibit the presence of DT. The study also included 12 healthy adults as a control group for comparison. The researchers measured the mRNA levels in all the participants by extracting peripheral blood mononuclear cells (PBMCs) from blood samples. While all the participants were required to provide blood samples on the first morning of the study, the AD patients provided additional samples on the second morning of their alcohol withdrawal treatment (considered the baseline measurement) as well as their seventh day of treatment.

As a result, the AD patients showed dramatically lower levels of the circadian rhythm gene at baseline compared to the control group. Even after one week of detoxification treatment, these AD patients still exhibited low levels of the gene, with little restoration having occurred. Furthermore, the mRNA levels found in the DT subgroup did not differ from the mRNA levels in the non-DT group, indicating that chronic alcohol use in general drastically affects the production of this circadian clock gene.

Even though the study only examined the first week of alcohol withdrawal treatment, the researchers’ findings prove that considerable lowering of the circadian clock genes are taking place among AD individuals due to their over-consumption of alcohol. Not only did the AD patients’ drinking behavior create serious damage to their circadian rhythm regulation, but it also created long-term impairment of this gene expression. As a consequence, these individuals’ body systems will experience chronic circadian rhythm dysregulation, and may lead to immediate and long-term health complications.

The study by researcher Ming-Chyi Huang and colleagues from the Taipei Medical University in Taiwan will be published in the November print issue of Alcoholism: Clinical & Experimental Research.

There is a secret that can help you go through this initial phase a whole lot easier: Take bite-sized steps in recovery.
Bite-sized steps – what does that mean? Let’s use meals as an analogy.

Taking bite-sized portions means you only put a small amount in your mouth at a time. You fully chew each bite before taking another. Furthermore, you put smaller portions on your plate to begin with. Now, look at recovery in much the same way. Rather than go flat-out with a complicated regimen, trying to attack all your goals at once, running here and there and getting nowhere, gradually ramp up your daily activities. Do only what is absolutely necessary at first. Later on, you can modify, add, eliminate, or replace.

Focus on Your Needs

It may sound selfish, but it’s not. In early recovery, you need to focus solely on your needs. You’ve just been through an enormous change – getting clean and sober, learning about the disease of addiction, learning how to identify and recognize triggers to use, getting instruction about and practicing coping strategies and techniques. Your head is probably still whirling with all the things you were presented with during treatment. Not only that, but you discovered something about yourself that you didn’t even know you had: the ability to make a profound life change.

You don’t want to jeopardize your newfound sobriety by taking your focus off what’s really important in these first few days, weeks, and months of recovery. You simply have to tune out all distractions to your all-encompassing goal of maintaining sobriety.

For many, this is easier said than done. You may be returning home to a family that’s dependent on you as the breadwinner – and it’s been difficult while you were gone to treatment. Naturally, they and you will have expectations, wants, and needs. You will find yourself torn between doing what you know you need to do for your recovery plan and what the family wants and needs. This can prove very tough and, if not handled properly, can quickly derail your sobriety. You can’t be all things to all people, not your family, friends, employer, or anyone else. For now, you have to focus on your needs alone.

Communicate with Family Members

One way to ease the strain of returning home is to have a loving but honest conversation with your spouse or partner, parents, children, or other family members living with you. You can do this individually or in a group, and talk with each one separately to address any concerns. For a couple without children, it’s more clear-cut. Speak with your spouse to lay out a preliminary plan that you’ve been recommended to follow by your therapist. When your spouse knows that this is part of your overall ongoing recovery program, it may be more palatable.

What should you say? Begin by reaffirming your love and appreciation. Let your partner know how much his or her understanding and patience means to you – not only during your treatment, but also in this first phase of your recovery. You could say that you certainly don’t have everything figured out and you know there will be some rocky times, but with love, understanding, and support, you’ll both get through it just fine. Mention that you’ll need to do some things on your own as part of your recovery, now and in the future, but as much as possible, you will be as present as you can be in the relationship and will include your partner whenever appropriate.

Children also need to know the basic ground rules, but they don’t need an exhaustive explanation. You’ve been in treatment and now have some things your therapists recommended that you do to keep yourself healthy and ensure that you’ll be around to be their father. Use whatever words will reassure your children. Tell them and show them that you love them – but don’t try to smother them, overcompensate for being gone or to make up for past misdeeds. Just love them, talk with them, and strive for honest interaction at all times. If there have been some particularly rough times in the past as a result of your addiction, recognize that your children may take some time to again trust you. If they’re aloof, defiant, anxious or depressed upon your return home, it may very well be that they’re afraid that things will go back to the way they were. It’s a matter of self-preservation, of survival. All you can do is to say that you are much better now and are going to work hard every day to make sure you stay this way.

First Things First

Okay, after you’ve determined that you’ll focus on your recovery needs, and you’ve begun to communicate with your family that your first priority is to concentrate on your recovery, what should you do next? Even though you may be exhausted by all the excitement of coming home, don’t fall back on the couch and let the hours pass. You need to initiate your recovery plan. This is the plan you created with the help of your therapist before you completed treatment. It contains the recommendations for action steps, short- and long-term goals that will sustain you during your first months of recovery.
Note that recovery is an ongoing process. It isn’t something that you have now and can forget about. You have to work at recovery. Although it may seem difficult or strange or frightening at first, know that it does get easier. Over time, you won’t even have to think consciously about certain things you do in recovery. You’ll just do them. They will become a part of your life, as basic, life-giving, and natural as breathing.

So, right now, get out your recovery plan and study it. Take a look at the first things you’ve set out for yourself as priorities. These may include lists of daily activities or a general focus on areas you’d like or need to address. Most likely, your recovery plan includes making a daily schedule to help keep you on track. This simple step – making a daily schedule – helps keep those in recovery better focused on what they need to do when. There’s no way to forget that there’s a meeting you need to go to, not if it’s listed right there on your to-do list for today. And, make no mistake about it – going to your 12-step meetings is a priority for the first 90 days of your recovery.

Speaking of bite-sized steps in recovery, while you’re studying your recovery plan and making out your daily schedule, be sure to include all time increments throughout the day. Here’s a simplified view of a typical daily schedule.

• Plan to get up at the same time every day
• Eat breakfast (no skipping this all-important meal)
• Get ready for work or your day
• Go to any scheduled doctor or therapist appointments
• Take any prescribed medication as directed
• Meditate
• Exercise
• Eat lunch
• Go to 12-step meeting or meetings (you may need them several times a day in the first few weeks)
• Do errands, tasks or projects that need attention
• Have dinner and spend time with the family
• Meditate
• Plan your schedule for the next day
• Rest and relax, and
• Go to bed at the same time every night

Obviously, in the first few days and weeks, your daily schedule will be more concentrated on putting your strategies and techniques into practice, attending 12-step meetings, healing your body-mind-spirit, re-connecting with your family, and regaining your self-confidence and trust in your ability to make the right decisions in your recovery.

No Major Life Changes in the First Year

Addiction recovery experts and 12-step groups alike recommend that there be no major life changes made during the first year. Of course, there are some times when the choice is out of your hands entirely. If someone close to you dies, or falls seriously ill, gets injured in an accident, or you lose your job due to a collapsing economy, for example, these are major life changes over which you have no control. But to the extent that you have the ability to make or not make major decisions affecting your life, put them off during the first year.

Some examples include buying a new home or selling the one you have, deciding to get married or divorced, opting to have children, quitting your job, selling everything you have and going off to live in isolation, and so on. Whatever it is, if it seems extreme or a major departure from your normal life, you probably shouldn’t be doing it – at least, not now. If, after a year of sobriety, you still feel that this decision you’re contemplating fits best with your overall recovery goals, then that may be the time when you can begin to look at it.

There’s an underlying reason why experts recommend no major life changes during the first year of recovery. Major life changes are huge stressors. When you’re stressed, your body suffers. Your overall balance is thrown off and you’re less able to withstand the cravings and urges. As stress mounts, the situation worsens. You may suffer anxiety, depression, and sleepless nights. You may feel more agitated, quick to anger, make inappropriate remarks, bad decisions at work or at home. You may fail to recognize a trigger or be incapable of resisting the temptation to use. You want to escape the pain. You’re tired of thinking of all the problems. You just want release. You’re on the road to relapse.

That’s the danger with making major life changes.

Manage Day-to-Day Stress

What about the stress you encounter on a day-to-day basis? Again, using the bite-sized steps analogy, make it a practice to use your coping mechanisms on an incremental basis. Let’s say that your job is filled with stress: deadlines to meet, correspondence and reports to write, keeping the boss and your employees informed, fierce competition inside and outside the company putting your nerves on edge. When you come home, you find yourself feeling short-tempered, in a foul mood, like your head is gripped in a vise and ready to explode. How can you manage this kind of stress?

One solution is to take the time to separate your consciousness from the stress. Many people do this by meditating. This technique can be as simple as sitting in a quiet, darkened room and closing your eyes. Concentrate on the sounds of your breathing going in and out. Count or say a phrase in a repetitive fashion. You can also learn how to meditate by buying a CD, DVD, or book or by taking instruction. Other ways to get outside your stress include Pilates, yoga, and deep breathing exercises. Again, you can teach yourself or learn from an instructor.

Look back at your daily schedule when you find yourself engulfed in stress. What things can you eliminate or cut back on from your daily routine? Start carving out small blocks of time – say, 15 minutes twice a day – during which you can be by yourself, calming your thoughts, becoming more centered, more relaxed. This will help you when you come back from your mini-breaks to be better able to focus on the issue or task at hand – without being overwhelmed by stress.
Talk over how to handle stress with other group members during your 12-step meetings. Techniques and tips that work for others may prove helpful to you. In addition, things that you’ve discovered are effective for you may be of use to others. Brainstorming ideas as a group is also good.

Gain a Healthy Perspective

Releasing the burden of your addictive past is necessary to be able to move forward in recovery. You undoubtedly talked this over with your therapist during treatment and, to the extent that you have continuing therapy available to you as part of your aftercare program, you may still do so. It’s important as you progress through the first few weeks, then months, and the first year of recovery that you begin to see where you’ve made significant progress. Being able to look at the gains you’ve made toward achieving your recovery goals is proof positive that helps you realize something incredibly important: It helps you gain a healthy perspective.

Think about this for a minute. When you first begin recovery, everything’s kind of up in the air. You don’t know if you’ll be able to make it through the first days, let alone weeks, of being on your own. What if you can’t take it? What if your former drug- or alcohol-using friends drop by and you can’t help yourself and start using again? What if your spouse leaves you and takes the kids? What if you blow up under pressure and tell your boss off – only to get fired or demoted? What if recovery is too boring or you’re too depressed or anxious? What if, what if, what if….?

Taking bite-sized steps in recovery means checking back to see the small improvements you’ve made each day. It takes a little time to be able to recognize these advances. You won’t necessarily see them after just a few days. But over a week or two, you can definitely see some things are becoming a little easier. Add up the days you’ve been sober, for example. That’s a great start and proof that you’ve made a significant achievement.

Live in the present and give yourself credit for the good things you’ve done for yourself and your recovery today. Thank your higher power or spirit or the power of the self for the opportunity to see life with all its challenges and possibilities.
Will every day be progress? No, that’s not how it works. Some days will be good. Some will be fantastic. Others will be challenging in the extreme, or feel like a stagnation or even setback. But recovery isn’t a straight-line process. There will be good days and those that are not so good. Consistency is what matters. Adhere to your recovery plan, refining it as you go along. When you achieve a short- or long-term goal, you should always have new ones to take its place. Always strive toward what’s next on your list, while enjoying and being firmly present in the here and now.

Take the time to enjoy all of life’s riches. This includes loving your family, spending quality time with them as well as with your friends, working at a job you enjoy or doing something you love with a passion. Be in nature and fully appreciate the beauty and symmetry – and awesome power. Life is all around you and in you, creating, evolving, and moving forward.
Final recommendation: Take life one day at a time. This is a bite-sized step that makes recovery not only well within reach, but so much easier to manage. Now, go do it.

Blame is Counter-Productive

Think about all the statements you’ve ever heard people make where they assign blame to someone else for whatever the topic is at hand. They blame the policymakers in Congress and the President for the state of the economy, rising taxes, joblessness, national security, immigration policy, healthcare, Social Security, Medicare, and a host of other things. We blame our neighbors for their barking dogs, their ill-mannered kids, and their shoddy home maintenance that drives down the value of our homes. We blame our conniving co-workers for grabbing the plum assignments, our thieving company for not sharing profits or jacking up our healthcare premiums, deductibles, and co-pays. We blame and we blame and we blame. But blame doesn’t get us anywhere. Blame is just an exercise in futility, a way to vent that, in essence, is totally counter-productive.

The same holds true for addiction recovery. We can blame our parents for passing on the gene that makes us vulnerable to addiction to alcohol or certain drugs. We can blame our friends for leading us down the path to ruin by introducing us to cocaine or crystal meth or black tar heroin or prescription drugs to ease our various aches and pains or allow us to escape. We can blame ourselves for our cowardliness, our selfishness, our total lack of regard for the welfare of our loved ones. We can, and we often do.

But blame isn’t the answer. It never has been and it never will be. Instead of blame, what’s really more appropriate is a sense of personal responsibility. There’ll be more about that in a minute. First, let’s look more at where blame originates.

Blame is All in the Mind

People voice blame in their comments. But blame starts elsewhere. It begins in the mind. Blame is a clever way for people to divert their attention from what is real and needs attention. It allows them an escape route, a justifiable (in their minds) means of avoiding the truth. And the truth is always something too painful for them to readily accept, or something that they feel is out of their hands, or that they have no hope of resolving.

From this, it’s easy to see how blame gets in the way of effective recovery. When you allow blame to color your view of what’s possible, what, in the end, is ever possible? If you blame yourself for your failure to stay sober, your inability to stick to your word, your weak nature that propels you back into using – not only are you dead wrong, but you’re sabotaging your hopes of any lasting sobriety.

The mind is a very powerful tool. You can use your mind to aid in your recovery, or you can allow it to help you self-destruct in the quickest manner possible.

Blame is a Dead-End Street

Another point about blame is that it goes nowhere. Blame is a dead-end street. Once you or others start blaming for every thought, action, or result of inaction, there’s nothing that points to a need to do anything. You’re off the hook, neither being held accountable by yourself or others, nor required to do anything. How convenient, and how obviously germane to the subject of addiction recovery.

If you blame your parents for your alcoholism, it’s as if you’re giving yourself tacit permission to go on drinking. You’re saying, in essence, that it’s out of your hands entirely. You couldn’t stop biology, and this is the genetic hand you’ve been dealt. This gives you the excuse that you can keep on drinking, since nothing you do will change your heredity or your predisposition to addiction.

Guess what? You can do something about your addiction, whether you have a genetic component that makes you vulnerable or not. It does, however, require action on your part – and a lot of hard work. Part of the reason why people use blame is that they don’t want to face an uphill battle, especially if it involves overcoming addiction. Even if they do go through treatment, any little setback is conveniently excused by assigning blame.

The only way you’ll ever be successful in recovery is to do away with the blame game. It’s just not conducive to long-term sobriety.

How to Overcome the Tendency to Assign Blame

How you overcome the tendency to assign blame requires conscious effort and practice. Here are some tips:

• Learn how to identify blame statements. – Listen to the words that come out of your mouth. You’ll soon learn to identify those which are blame statements. They’ll be the ones that include phrases such as: “It’s all his/her/their fault,” or “She/he/they got us into this mess,” or “They’re the ones that drove down the economy,” and so on.

For a week, write down every statement you make – about anything – that is a blame complaint. Do this whenever you find yourself making the statement or at the end of the day, whichever is easier. Next to the blame statement, write down how you could have stated your concerns or made your case without assigning blame. To do this, you’ll have to think of viable alternatives. It could be anything from the point that consumers need to solidify in their efforts to oppose government intervention into areas that should be left to individuals or states, to the observation that no single person accounts for all the country’s ills.

You can see where this is going. Instead of blame, the statements are veering more toward responsibility. Responsibility implies action, and action allows for growth and change.

• Apply the same technique to your self-blame statements. – Now, catch yourself when you start thinking about your own situation and how you ascribe blame to yourself. Again, write down everything you remember thinking or saying where you’ve blamed others or yourself for your addiction.

These are your excuses that you’ve allowed yourself to perpetuate for perhaps many months and years. They’re also wrong and self-defeating. You may write, for example: “I’m a drunk because my parents were drunks.” While there is a strong genetic component in some family history that means some offspring have vulnerability toward alcoholism, it’s only one potential factor. It’s not a given. Not every child of alcoholic parents will become an alcoholic – although many may, given other factors, including environmental and peer influence. Here, you’re blaming your parents for the fact that you are an addict. Where is your personal responsibility?

Don’t worry, for now, about how to translate the self-blame statements into something more appropriate. It’s enough to become aware of them. If you do think of a better way to talk about your addiction, write these new thoughts down. You may, for example, come up with some good ideas that you hear from others in your 12-step group meetings or from discussions you have with your 12-step sponsor or your therapist. As you’ve undoubtedly learned during treatment, being aware of something is the prerequisite to making the conscious decision to change such thoughts and the resulting behaviors.

• Don’t allow others to blame, either. – As you become more aware of your and others’ tendency to assign blame, make it a practice to not allow blame statements to go unchallenged in conversations. This is not meant to suggest that you become argumentative, only that you learn how to veer conversations into a more productive vein.

How to Begin Accepting Responsibility

It’s one thing to say that you should stop using blame as an excuse and start being responsible for your own actions. Easier said than done, many would say – and they’d be right. You need to do more than tell yourself that you’re going to begin accepting responsibility – but it’s at least a start in the right direction. Acknowledge to yourself that, beginning now, you will make it a point to become responsible for what you say and do, and how you think about your role in your own recovery.

Perhaps it’s best to initiate this practice by starting small. In this regard, look at the big picture, but don’t try to carve off too much in the way of responsibility. If you take too much on your plate – whether it’s promising to do too much at work or home or school or for your own recovery goals – you’re setting yourself up for failure or disappointment and, you guessed it, another round of self-blame.

Addiction recovery experts often say that newcomers to recovery take bite-sized steps. Don’t make any major life changes during the first year. Tend to your recovery needs first and foremost. Allow yourself time to acclimate your daily routine to include your 12-step meeting attendance, doctor and therapist visits, and other critical appointments and recovery needs.
Although returning home after treatment is a very big deal, it’s best if you ease into it. Just because you’re back home doesn’t mean that you can or should expect yourself to figure out everything at once, to solve all the household or family problems, to be all things to all people. Again, this is setting you up for failure. You’re too raw, too new to recovery to be able to handle all that stress – without burying it under a mantle of blame.

Talk with your spouse or partner, your children, and any other adults living with you. Let them know that you have learned a lot about your addiction and will be putting into practice what you learned. Ask for their understanding, encouragement, and support as you begin this all-important early phase of recovery. Acknowledge that things will be a little different, as you attend to your recovery needs, but this does not in any way lessen your love for them – or your intention to be there for them now and in the future. By having this conversation, as many times as you need to, you’re setting the stage for expectations. You’re neither promising too much nor too little. In fact, you’re stating what is true and appropriate, given your situation.

In line with your personal responsibilities at home, beside those pertaining to your recovery – which has to be primary for you for now – you also have responsibilities to your spouse or partner, and your children. There are also your financial responsibilities, especially if you are the breadwinner. Take care that you don’t overwhelm yourself with assuming too much too soon.

How about at work or at school, as appropriate? You certainly have responsibilities there as well. After being in treatment for some period of time, you’d be understandably anxious about being gone for such an extended period. What have you missed in your absence? Have you lost your standing in school, jeopardized a scholarship, or failed a term? Have you suffered a demotion at work, missed key project deadlines, been assigned to lesser-important teams or have you lost your job? Take it easy. Don’t allow these consequences of your addiction to sideline your recovery. You need to take the long view. Accept that these things happened as a result of your addiction. You really need to take personal responsibility for your actions that resulted in these consequences. Don’t blame your addiction. Your addiction is a fact that you can’t change. But what you do about your addiction can and should change. You are not defined by your addiction. Your future is what you want to make it.

But a lot depends on you being able to squarely face your responsibilities and to create and adhere to your plan to do what you need to.

Many newcomers to recovery fear that returning to work will be a disaster. They feel ashamed, full of guilt and self-blame, awkward, inept, a failure, unable to fulfill commitments. One suggestion is to arrange a time to talk with your boss or immediate supervisor. He or she already knows that you were in treatment for addiction and is probably eager to see that you are well on the road to recovery. After all, you as an employee are important to the company’s success. Your boss wants you to succeed so the company will as well. Acknowledge his or her support of your recovery efforts. Commit to doing what it takes to continue your sobriety, including the fact that you will be regularly attending your 12-step meetings. Ask for patience and understanding as you gradually ramp up to speed in your projects. Any reasonable supervisor or boss will be receptive to this approach. Again, your contribution is valuable – and you need to be fully present in order to make a contribution.

It’s also a good idea to talk privately with your team or co-workers, particularly those that are important to your work responsibilities. You don’t need to go into detail about what happened during treatment. It’s sufficient to tell them that you’re better now and glad to be back. You could say that you welcome their ideas and appreciate their help as you get back up to speed on current and future tasks and projects. The specific words you use aren’t as important as the manner in which you deliver them. Portray a confident, self-assured attitude, but not one that’s cocky, or defiant, or groveling. Recognize that there may be some lingering feelings of resentment over having to pick up the slack caused by you not being there, but this should quickly pass as they see that you are, indeed, back on the team. Just take it slow. Don’t overpromise and under deliver. By promising too much too soon, you’ll become exhausted, out of sorts, agitated, nervous, depressed, anxious and – once again, prone to self-blame.

Take the Long View of Recovery

When you accept responsibility, it’s a healthy and productive sign that you are fully cognizant that recovery is very much what you make it. Keep in mind that recovery is a lifelong process from here on. You will always be in recovery, just as you will, as long as you continue breathing, be alive. Make your life the most productive, happy, and fulfilling as you can. Take the long view – and then challenges that surface today and tomorrow will be easier to overcome.

Most of all look at recovery as an opportunity to experience all the joy and riches life has to offer. These are likely things that you thought you didn’t deserve, or that you lost forever. But you not only deserve them, they are right here waiting for you. All you need to do is take it one step at a time. Be responsible. Be you. Be free to live your life in sobriety. Start today.

An aortic dissection, also known as dissecting aneurysm, is a serious condition involving a tear in the inner layer of the aortic wall, causing blood to fill between and separate the inner and middle layers. If blood makes its way to the outer layer of the aortic wall, the dissection is likely to be fatal. Because amphetamine abuse can lead to heart damage, researchers from the University of Texas Southwestern Medical Center investigated whether amphetamine abusers are at higher risk for aortic dissection.

Researchers Drs. Arthur Westover and Paul Nakonezny conducted a population-based controlled study using medical records from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample between 1995 and 2007 on 30,922,098 patients aged 18 to 49 years. The medical records included in the database were gathered from California, Hawaii, Oregon, and Washington state, where amphetamine abuse has historically been more prominent. Of the study’s sample, 3,116 patients had thoracic and thoracoabdominal aortic dissections. Researchers discovered that patients who had a history of amphetamine abuse were three times as likely to experience an aortic dissection.

Typically, aortic dissection is considered to be more common among male adults aged 50 and older. However, in the researchers’ investigation, younger adults were more likely to experience aortic dissection than people 50 and older. The researchers compared the data on patients aged 18 to 49 years to the medical records of more than 49 million patients over the age of 50 during the same time period. As a result, younger adults displayed a higher frequency of aortic dissection than older adults, although the researchers could not confirm the cause of this disparity. They suggest, however, that the availability of amphetamines on the west coast may contribute to higher levels of amphetamine abuse, and therefore may have led to higher occurrences of aortic dissections among this population.

A similar study by the Substance Abuse and Mental Health Services Administration (SAMHSA) released last year found that full-time college students between the ages of 18 and 22 were twice as likely to abuse Adderall—a prescription brand of amphetamine used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy—as their peers who do not attend college full time. The study also found that amphetamine-abusing college students were three times more likely to abuse marijuana, eight times more likely to abuse cocaine, eight times more likely to abuse prescription tranquilizers, and five times more likely to abuse prescription pain relievers. Furthermore, 90% of these amphetamine-abusing college students were classified as binge drinkers.

According to the Center for Disease Control and Prevention (CDC), 6.8% of 12-grade students had abused amphetamines in 2007, with Adderall as the most popular amphetamine of abuse (2.8% of 12-graders admitting to misuse of the medication). Based on these findings, amphetamines had become the third most abused drug among this age group for that year.

According to SAMHSA, amphetamine/methamphetamine abuse is on the rise nationwide. In a recent study, treatment admissions for amphetamine/methamphetamine abuse had risen from 13 admissions per 100,000 in 1993, to 56 admissions per 100,000 in 2003. SAMHSA also found that Hawaii, California, Oregon, and Washington were four of the top 12 states in 2003 to have a rate of treatment admissions for amphetamine/methamphetamine abuse that exceeded the national average.

Westover and Nakonezny suggest that amphetamine abuse or dependence among young adults may make them more susceptible to aortic dissection. The researchers recommend that physicians who screen patients with aortic dissection should consider amphetamine abuse as the possible cause of their condition, especially among younger adults. Their study was published this month in the American Heart Journal.

Source: Reuters, Maggie Fox, Amphetamines could damage heart artery: U.S. study, August 17, 2010

The answer to that question is a resounding “No. In recovery, and life in general, stagnation implies lack of movement. When you’re in recovery and just going through the motions, not really into making progress toward your goals, not challenging yourself to tackle something new and different, you’re resigning yourself to sameness. That’s a dangerous position to take. Sameness soon equals boredom, and boredom looks for something exciting to jumpstart existence and to bring novelty back into life. Often, that novelty is a return to using. So, stagnation is not a good thing. It’s an issue that needs to be resolved. But how do you do that?

Here are some suggestions on how to overcome stagnation in recovery for addition?

Get a Check-up

One of the first things to do is to get a check-up. There may be something wrong physically that’s causing you to lose interest in doing anything to further your progress in recovery. It could be as simple as low resistance causing you to be susceptible to colds, flu, or viruses. You could be exhausted from taking on too much recently and your body has gone on strike, needing a well-deserved break.

Or there could be a psychological issue that you need to address with your counselor or therapist. You can’t know what it is unless you get yourself checked out. You may suspect, but you aren’t a doctor or a psychiatrist. Why guess? Make an appointment with your doctor and/or therapist and either rule out an underlying physical, psychological or emotional issue or have it treated.

Examine What’s Going on in Your Life

If you’re okay physically, or if whatever ailment you have is able to be corrected with medication, treatment, and time, the next step is to look at what’s going on in your life. Your doctor or therapist probably already asked you if there’s something different that may be causing your feeling of malaise. You may have replied that everything’s the same, that there haven’t been any major changes. But is that true, really? Now is the time for you to examine what’s been happening during the past few weeks and months.

To do this most effectively, set aside some time when you won’t be interrupted. Give yourself an hour, just to be safe. You’ll need this time because the first few minutes you’ll probably find your mind wandering – thinking about everything but what you need to. It’s often helpful to meditate for a few minutes before diving into this step. Once you feel calm and relaxed, you can begin.

Start by thinking about your home life. If you have a family, have there been issues that have come up with your spouse or partner, your children, siblings, parents or other adults living with you? Is someone seriously ill? Are you in financial trouble? Is there drug or alcohol use among others in the family? Have there been arguments, unexplained behavior, mood swings, secrecy, lies, or other signs of strain in the family?

How have you been communicating with your loved ones about your recovery needs? Have you pretty much kept things to yourself, going to your 12-step meetings, to and from work, keeping a rigid schedule so you’re not tempted to use? Do your family members tiptoe around you, fearful that anything might set you off or result in a relapse? Do they resent you not spending enough time with them? What about the children? If your routine is mysterious or seems to them to deprive them of your presence, this could be a source of the stagnation you feel. You’ve basically allowed yourself to fall into a rut – doing only what you need to do, keeping to yourself, not communicating your needs or listening to your family members.
Next, think about the past few weeks and months at work. How have things changed since your return to your job after completing treatment? Are you treated with kid gloves? Do you feel that others are talking about you at the water cooler or coffee machine? Have you had a hard time getting back up to speed on your assignments or projects? Is this why you’ve spent extra hours trying to play catch-up? If so, the tedium of constant work could very well add up to your feeling stagnated. You may push the feeling down, but it’s always there. With so much to do, so many things to make up for (in your mind, at least, even if not in the mind of your employer), you’re bound to have some residual resentment. If you can’t see a way out of the current situation and it looks like you’re in for more of the same for the foreseeable future, this is also a prime condition for stagnation.

What about friends? Have you given up on outside friendships after treatment? You can’t just cut yourself off from outside friendships and not have it work against you in the long term. Sure, you did need to sever your relationships with your former drug- or alcohol-using friends, but did you even bother trying to find new friends – those who are clean and sober? If not, or if you gave up without really much effort, this could also be a factor in your current stagnation.

After you examine what’s going on in your life, you’re ready for the next step: Doing something about the stagnation.

Take a Break

Everyone needs some time off. Taking a break, in this instance, refers to making a conscious decision to change your everyday routine. You could, for example, suggest to your spouse or partner that you all take a family vacation. Chances are you haven’t been away with the family for a while. You’ve been too busy getting back to normal or the new normal in your newfound sobriety, going to work, 12-step meetings, working your steps, getting re-acclimated with the family. A family vacation may be just what everyone needs – especially you.

It doesn’t have to be anything elaborate, especially if money is tight. Instead of going on a week-long trip, you can do a week-end camping excursion, even a day trip to the beach or mountains. Go to an amusement park. Take the family to auto races. Visit museums or planetariums or go to an open-air concert. The key is to plan the activity with your family members well enough in advance so that everyone has something to look forward to. This brings an element of excitement to the family dynamic. It gives you all something to talk about, to make plans for, and to share up to and during the little break. So, it doesn’t matter where you go or what you do. What matters is that you take the time to do something that’s out of the ordinary routine, something that everyone can enjoy together as a family. It’s also a way for you to jumpstart yourself out of stagnation.

These mini-breaks can occur whenever you feel the need to re-energize your life. Plan something special once a month as a family, or twice a year, around holidays or whenever an opportunity arises. Think of these breaks as an instant lift, an easy way to do something that’s beneficial for you and your loved ones.

Learn Something New

In stagnant water, nothing moves or grows – except pond scum and algae. When you feel that your life in recovery has become stagnant, the quickest way to alleviate that is to get involved in learning something new.

That something new can involve learning a craft, taking up a hobby, receiving instruction in or practicing a sport, taking up an exercise program, or dancing, swimming, cross-country skiing. If you’ve never done it – and your doctor says you’re physically fit enough to go ahead – why not give it a try? This is especially recommended if the activity or pursuit is something that you always wanted to do, or often dreamed of doing. Even more so, if you’ve previously told yourself that you couldn’t possibly do this or that – because of lack of self-confidence, fear of failure, or some other reason.

When you’re actively involved in learning something new, your mind is engaged. You don’t have to think about getting over stagnation. In the process of learning something new – or getting better at something you already know how to do – you’re already moving past stagnation. You’ve tossed the stone in the water, so to speak, and the ripples are already stirring up movement within.

And, to make things even more interesting, why not include your spouse or loved one, and/or your children, in your new activity? Make it a family endeavor.

But learning something new can also be a part of a long-term goal. If you’ve wanted to get or complete a degree, learn how to speak and write a new language, find out more about geology or spelunking or deep-see fishing, add these to your list and get busy figuring out where and how you can get started.

If you’re a homemaker with small children to take care of, or if traveling outside the home isn’t really an option right now, you still have opportunities to learn something new. There’s always the Internet. You can take classes for various degree programs online. Join a writing group that meets online. You could also take a home-study course, or have friends with like interests meet in your home (knitting, crocheting, cooking, painting, jewelry-making, and so on). From time to time, take a field trip with friends or other group members to attend lectures, visit historical sites, or go to a Shakespearean festival.

The possibilities are endless, once you put your mind to it. Go ahead. Give it a try. Make a list of things you’re interested in and want to pursue. Then figure out what it will take to get started doing it. Then just do it.

Figure Out How You Can Give

Maybe all that’s necessary to overcome stagnation in recovery is for you to get outside your own issues and do something good for someone else. When you reach a certain point in your recovery where you’re stable and confident enough that you have the tools and ability to overcome cravings and urges, handle stress without danger of relapse, and feel supported and encouraged by your family and 12-step group sponsor and members, one of the best things you can do for yourself to stimulate growth is to begin to give back.

Giving back may mean that you go out of your way to help a neighbor in need. Perhaps that neighbor is a widow or widower who is unable to do tasks that need attention around the house. Maybe he or she is bedridden and unable to go out for groceries. You could offer to bring supplies from the store, or take it upon yourself to do the yard work (raking up leaves, shoveling snow, pulling weeds). Bring over a casserole or pot of stew or hearty soup, or a basket of fruit or bouquet of flowers. Better yet, offer to play Canasta or Scrabble or watch movies on TV or, just spend time in conversation. When you’re elderly and/or infirm and alone, having someone to talk to is a pure gift. Many people go about their own lives never giving a thought to how others may be lonely and afraid. By taking the initiative, you could make a big difference in such a life. It’s just one example of how easy it is to give back.

Another way to give back is to be an ally to a newcomer to recovery in your 12-step group. There are always people coming into meetings who are anxious, unsure, a little suspicious or afraid of how things work. Think back to when you first started going to meetings. Someone took notice and talked with you, offering to answer any questions you had. Maybe you struck up a kind of friendship over time. This person may even have become your sponsor or, at the very least, someone you looked forward to seeing regularly at meetings. Try offering support and encouragement on a personal (one-on-one) basis to someone new to recovery that seems to be open to such an approach. If they’re hesitant, that’s okay. It may take a little time. Just say that you’re available to talk if they need to, or if they want to discuss how things work at meetings.
There are many other ways to give – or give back. If someone at work is having trouble completing an assignment, you could offer your assistance or guidance. You won’t be doing the project for the person, just helping them with tips or professional advice. Who knows? Such kindness may turn out to have long-term benefits you can’t even imagine now. One thing is certain: When you get outside yourself and seek ways to help others, you’re automatically moving forward and out of stagnation. You’re doing something positive, and that’s life-affirming and extraordinarily effective in recovery.

Enrich Your Spirit

Along with taking a break, spending time with the family, learning new things, and giving to others, it’s also important to pay attention to your spiritual needs. We all have them, whatever we call it. Whether it’s God or god or the higher power or the power of nature or the power of self, your spiritual needs require nurturing. You can’t just ignore your beliefs or the innate sense of what truly is – after you strip away all the thoughts, emotions, issues, concerns, physical aches and pains. What’s at your core is your spirit. It’s either nurtured by you as a conscious pursuit, or ignored and shrivels up.
To thrive, your spirit needs attention. Just like flowers need water and sunshine to grow – your spirit can’t just keep on going without you paying attention to its needs.

How do you get in touch with your spirit? How do you know what it needs? How do you talk with God or have God get in touch with you? How does all this spiritual enrichment occur? The answer is different for everyone.

Many people find that meditation helps them get in touch with their spirit and their spiritual needs. Yoga, Pilates, deep breathing exercises, prayer – even walking in nature – may be the path for your to discover what and how your spirit talks with you. Many don’t even realize that when they spend time alone with their eyes closed, breathing in rhythmic cadence while uttering a phrase or mantra, or listening to the sound of their breath going in and out, that they’re calming the chaos and distractions of life around them. They’re getting in touch with their inner self. They’re attuning their body and mind to peace. That’s when the spirit can become enriched. Things that may have clouded the picture before may fall away or seem less important. What’s really important in life – living up to your full potential, feeling the joy and love for and with your family, finding a sense of purpose, living every day in the present – will become clearer. It’s at least a good start.

Look Forward with Hope

When you take any or all of these steps, you will be well on your way toward overcoming stagnation in recovery. Remember that recovery isn’t a straight-line process. There are good days and those that are less than ideal. Some days may be more of a challenge than others, causing you to want to revert to your old stagnation as a means of escape. Acknowledge that this happens, and go on from there. Instead of stuffing the feeling down, let it make itself known and then affirm your intention to keep doing positive things in your recovery.

The longer you practice what you’ve learned in treatment and through your support groups, the more time you have in recovery, the more that you are able to recognize stagnation or other troublesome issues that crop up from time to time, the more firmly you are grounded in recovery. Over time, what once may have thrown you for a loop is easily handled. You have the strategies and techniques in your recovery toolkit to sustain you. You are in the process of evolving and creating and doing. No more stagnation for you. With evolution and creation and doing comes growth. With growth comes hope. And hope is something you can take to the bank – your recovery bank. When you look forward with hope, anything is possible in recovery – today, tomorrow, and for the rest of your life.

That said, the times when you really need to go to 12-step meetings may be inconvenient, impossible to schedule, or otherwise unavailable to you. People around you, those you work with, even friends and family members, may not understand or appreciate or even tolerate your frequent absences from where they feel you’re supposed to be in order to attend your meetings. What you say at those times may make the difference between your peace of mind and, frankly, your job, your family, and your friendships. So, what are some things you can say when you have to go to a 12-step meeting?
Here are some suggestions.

If the Meeting is Already Agreed Upon

There are, of course, different situations to consider. Let’s take the fact that your employer, for example, is well aware of your history of addiction, treatment, and your recovery efforts. He or she knows that attendance at 12-step meetings is crucial to your being able to sustain your sobriety. Whether it’s mandated as part of corporate policy through the human resources department (for ongoing employment following treatment for alcohol or drug abuse), or just good business practice on the part of your boss or supervisor to keep you productive by permitting attendance, it’s in the best interests of the company that you do regularly attend your 12-step meetings.

When you really need to go, however, may conflict with your work obligations. You may need to miss a meeting – even one you called – or postpone a business trip or client presentation. You may need to come in later, take more time at lunch, or leave early. Other employees will undoubtedly notice and may carp to your boss, their supervisor, among each other, even to you. It’s not fair. You’re not pulling your weight. They’re tired of picking up the slack or covering for you. The litany of complaints is common. Still, you need to attend your 12-step meetings. How should you handle it?

• Schedule a time to discuss it with your boss. – First things first. You need to schedule a meeting with your boss or supervisor at a time that’s convenient for him or her in order to discuss your situation.

• Lay out your case. – Don’t just go into the meeting demanding that you be allowed to go to your 12-step groups. That will only jeopardize your chances of reaching an equitable compromise. You need to lay out your case in practical terms. You need to give your boss reasons that will make it easier – even a no-brainer – for him or her to give the go-ahead. In other words, you offer solutions that he or she really can’t say no to. At the very least, you will give your boss something to think about and maybe from there you both will be able to reach a mutually-agreed upon compromise.

• Strive to reach compromise. – While every situation is different, let’s say, for example, that your home-base 12-step meeting – the one you attend on a regular basis and feel most comfortable with – occurs in the morning. It may be at 7:30 a.m. or 11:00 a.m. or anywhere in-between. If you need to take an hour to attend this meeting, and factoring in the amount of time it takes you to get to/from the meeting location (depending on whether you go there directly from home before work, or leave work to go there and then return to work), you may need an hour to two hours out of your work schedule to do this. What’s in it for your boss? You’ll need to present your case showing that you’ll make up the time lost by working later, or coming in early, or some other solution. It doesn’t matter what the specifics are here. What’s important is that you can document how you’ll make up the time, tend to your assignments or work load, finalize your projects, meet – or better yet, beat – your deadlines. Make the case that your attending 12-step meetings will result in your ability to be even more productive and efficient.

• Consistency matters. – The same type of preparation will work for times when you need to leave early to attend late-afternoon or early evening 12-step meetings. You need to try to be consistent about your 12-step meeting attendance with respect to your work situation in order for this to be palatable to your boss.

What About Unscheduled Meetings?

In your discussions, you may wish to bring up the point that if it becomes necessary, you may need to go to a 12-step meeting at a time that’s not regularly scheduled. The best way to approach this is to say that you’ll only do so when absolutely necessary, and that you feel this should only occur during the first 90 days of your recovery. Giving your boss a time limit – and a reason – is your best ammunition. It also makes sense, since the first 90 days of recovery are the most critical. It’s during this time that you need the most support and encouragement from your 12-step group sponsor, fellow group members, and your family.

How to Handle Co-Workers

Handling the situation with your co-workers is a little different in some respects. As long as you don’t report to them, they don’t have authority over you. But you still need to have an amicable and good working relationship with them in order to maximize work productivity. For those whom you work the closest with on a day-to-day basis, a brief and frank conversation may be all that’s needed. After all, they probably are well aware of your past addictive behavior – or at least suspected it. They’ll likely know that you were in treatment and are now in recovery. In the best case scenario, they’re trusted co-workers who want only the best for you. No one wants to see their own jobs jeopardized or made more difficult by another employee’s inability to do the job they’re supposed to.

What your co-workers need to know is when and how long you’ll be gone, that it’s been approved by your boss, and that you’ll handle your work-related responsibilities in an appropriate manner so that nothing is jeopardized. Give them the reassurance they’re looking for, nothing more. They don’t need to hear the details about what goes on at the meetings or how you poured your guts out at the last meeting or couldn’t sleep last night because of incessant cravings and urges. That’s something you discuss at your 12-step group with your sponsor – not your co-workers.

Family Members Can Be Trickier to Handle

Of course, you don’t spend all your time at work. Much of the time when you’re not working, you’re at home. How you deal with your family members when you need to go to a 12-step meeting can be a little trickier to handle. They’re not the ones who control your employment, but the emotional bonds you have with family members may cause problems when it comes to your non-work time.

Your spouse or partner can either be a significant ally or a huge obstacle to your objective of attending 12-step meetings. This sounds counter-intuitive, doesn’t it? Why wouldn’t your spouse or partner want you to attend your group meetings when doing so is crucial for your ongoing recovery? It’s not always so cut and dried. On the logical front, of course your mate would want you to do all you can to sustain your sobriety. It’s more on the emotional level, the non-verbal communication level, where the problems can arise. After all, you’re taking time away from your spouse or partner and, consequently, the family, to go to your meetings.

If your family members attended family therapy while you were in treatment, this may be less of an issue. Still, there will almost always be some times when there’s resentment, bitterness, disappointment, or even resignation about your need to take off for meetings.

The only way to counter this is with love and understanding. Discuss your need to go to your 12-step meetings in a loving and gentle way with your spouse or partner. Let him or her know that it takes nothing away from your love for the family, but it is critical for your ongoing recovery. You will be in recovery for the rest of your life, but the first 90 days of early recovery are when you’re most vulnerable to relapse. You want to be able to handle your responsibilities as a husband or wife or partner, as a father or mother or sibling. To do so effectively, you need the support and encouragement of not only the family – first and foremost – but also your 12-step group sponsor and members.

Working the steps means that you have to make some very personal decisions and take actions that only fellow 12-step group members can understand – having been through them themselves. And while addiction is a family disease, affecting everyone in the family, it’s you who is the one overcoming the actual addiction. You have to do things that your other family members do not.

How can you make the situation more palatable? Here are some ideas.

• Arrange special activities/time with your loved ones. – Nothing says I love you like making a special effort to do an activity or spend significant time with your family. Start with paying more attention to your spouse or partner and branch out to include the rest of your family. Maybe you help your mate with a project or task that he or she enjoys. Perhaps you take time off to go on a mini-vacation or week-end sojourn – just the two of you.

• Say it with words. – Give him or her compliments on what they’ve done, how they look, how understanding they’ve been. Chances are such niceties have been long missing in the relationship. Going through addiction and treatment has been tough on everyone, especially your spouse or partner who most likely feels neglected, maybe even lonely. A few kind words, genuinely expressed, are like a breath of fresh air. Try it.

• Listen to what he or she has to say. – No one likes to feel as if they’re talking to a brick wall. When you’re so caught up in your daily schedule of work and meetings and doing what you need to do for your recovery, you may often not really be present for conversation with your spouse or partner. This is a mistake, but one that’s easily correctable. You can say, for example, that you know you’ve been a bit distracted lately, that you haven’t been paying attention like you should. Reassure your spouse or partner that you will be making a concerted effort to change this, starting now. Instead of just nodding your head or, worse, ignoring what’s being said completely, really listen to whatever it is your mate is saying. Make eye contact, giving him (or her) your full attention. When the time is appropriate, then make a comment. This will go a long way toward easing the tension at home and may make it less of an issue when you need to go to your 12-step meetings.

• Plan a family vacation. – Who doesn’t look forward to a vacation? It may be that you haven’t had one in a long time, due to expense or work or all the troubles associated with your addiction and subsequent treatment. A vacation may, in fact, be just what everyone needs. You all need time to rest and rejuvenate, to bring joy back into your lives, and to just have fun being with each other as a family.

It needn’t be prohibitively expensive, either, to do you justice. You can go away to visit family in another part of the state or other state. Drive, if that’s more economical. Besides being less expensive than airfare for all family members, you’ll have wheels when you get there.

But, let’s get back to planning the vacation. Get everyone in the family involved in the preparations – where to go, what you’ll do, what you want to take, how long you’ll be gone. Having something like a vacation to look forward to will give you – and other members of the family – a positive goal to work toward. It will also allow you to take care of business by going to your 12-step meetings in the days and weeks and months before you leave. You can say to your children, for example, that you’ll be glad to hear their ideas or go over their lists with them after you return from your meeting, or after dinner, or on Saturday morning – or whenever it is. Just be sure that you keep your word. This is very important, since it means that you can be trusted to do what you say. It means that normal family life is returning.

What If They Stand in Your Way?

Not everyone in recovery has understanding family members, friends, boss, or co-workers. In that case, you’ll need to stand on your decision to go to your 12-step meetings regardless of whether or not they approve, complain, threaten, or make your life miserable. Some things about recovery are non-negotiable. One of them is the absolute requirement for you to maintain a strong support network. Your family is one part of your support network. Your 12-step group is the other. If you have non-supportive family members, your 12-step group does double duty. Without either, you likely don’t stand a chance at being able to sustain your recovery.

So, bottom line: If you don’t have the support and encouragement of your family, or if your boss, co-workers, or friends can’t really see the need for you to go to 12-step meetings, it’s up to you to insist that this is what you’re going to do in order to be successful in recovery. It’s a part of your overall recovery plan, one that’s worked for millions of others who have successfully overcome addiction. It can and will work for you – if you stick to it.

What do you say to others when you have to go to a 12-step meeting? By now, you should have a few ideas of the kind of statements that may work for you. Use them as a starting point and craft your own. This is your recovery. Make it your priority. If you really want to be successful, there are no short-cuts. And, when and if life throws you another curve, your 12-step meetings may prove to be just the lifeline you need to weather the crisis.

One final thought. When you say you’re going to a meeting, you can follow it up with Arnold Schwarzenegger’s famous line: “I’ll be back.”

Prescription drug abuse has skyrocketed in recent years, affecting Americans of both genders, and all ages and demographics. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), treatment admissions for prescription drug abuse had increased by 400% within the past decade, and hospital emergency department visits related to prescription drug misuse rose by 111% in four years. More than half of Americans who abuse prescription drugs received the medications from a friend or family member.

As reported by Forbes, West Virginia was found to have an 18.4 per capita rate of retail prescription drug filled in 2009. The national per capita rate, on the other hand, is at 11.6 prescriptions. A year prior, Forbes also reported that West Virginia contained the highest rate of prescription drug utilization. Tennessee, Alabama, Kentucky, and Arkansas composed the remainder of the top five states for prescription drug use, all of which contained rates significantly higher than the national average, according to the study.

The high level of prescription drug use may be attributed to West Virginians’ greater proportion of serious health complications among its population. For example, the adult population in West Virginia was found to have an obesity rate of 68%, whereas the national average in 60.8%. Furthermore, 229.4 among 100,000 West Virginian adults have heart disease, compared to the national average at 190.9 per 100,000. About 12.3% of West Virginian adults have diabetes, as opposed to 8.3% nationwide.

Many of these residents have comorbid disorders, requiring the use of multiple medications by one individual, according to the state Bureau for Medical Services. Even though individuals with more than one mental, physical, or behavioral condition may require several medications, some individuals fail to see the danger involved in combining multiple (and highly potent) legal drugs. In addiction, West Virginia is home to some of the top regions for illicit substance abuse and tobacco/cigarette use among the nation, according to SAMHSA.

The U.S. Center for Disease Control and Prevention (CDC) confirms that 27% of West Virginian adults are smokers. Moreover, the CDC states that 30% of West Virginians have poor mental health and almost 20% have a disability (either mental or physical conditions). The misuse of prescription medications that are intended for treating many health conditions has become the leading cause of prescription drug abuse—making prescription pain reliever medications one of the leading abused substances nationwide, second only to marijuana.

Within the U.S., prescription drug purchases were found to cost Americans $234.1 billion in 2008, a six-fold increase from the bill in 1990 ($40.3 billion), reports the Henry J. Kaiser Family Foundation. Similarly, the amount of dispensed prescription drugs rose from 2.8 billion in 1999 to 3.9 billion in 2009, a 39% increase. While legal drugs are intended to help treat serious health conditions or alleviate pain, they do have the potential for abuse, or over-use. Many individuals tend to seek medications to cure their conditions, when instead they should have made effective lifestyle changes to improve their health and health care costs. Reliance on prescription drugs have grown to historic levels, exceeding the rate of the nation’s population growth.

Source: Forbes, Nathalie Tadena, America’s Most Medicated State? West Virginia, August 16, 2010

Knowledge about the Disease of Addiction

An addict can’t remain in the dark about the disease of addiction and have any hope of overcoming it. Before any progress can be made by the addict toward managing the disease, he or she needs to have a thorough grounding in all aspects of the particular addiction.

Such knowledge is best taught by addiction treatment professionals during the course of treatment for addiction, whether in a hospital-based inpatient or outpatient setting, or a residential inpatient or outpatient facility. In addition, recovering addicts continue to learn about the disease of addiction through sharing of stories and experiences in appropriate 12-step groups.

As new research into effective treatment modalities and medication become available, effective recovery also entails staying on top of whatever may benefit the individual’s ongoing efforts to maintain sobriety.

In other words, the pursuit of knowledge about the disease of addiction needs to be ongoing. More and more research is going on in the field of addiction prevention, treatment, and recovery. This offers a great deal of hope for those currently in recovery.

Strong Family Support

As an addict enters recovery – especially early recovery – the support of his or her family is critical to the ability to maintain and sustain sobriety. Coming home fresh out of treatment, the individual is, understandably, a bit fearful about his or her ability to handle all the stresses, the recurring triggers and cravings and urges. They’re vulnerable, lack self-confidence, afraid to make a mistake, and desperate for the support, encouragement, and understanding of the family.

In the best of circumstances, they are welcomed home by family members who have taken the time to go into family therapy to learn about the disease of addiction and how they can better support their loved one in recovery. This does not mean that the transition will be easy for everyone – not the returning loved one and not the family members. It is always a period of adjustment. Sometimes the adjustment is difficult. Many things may need to change within the family: schedules need to be altered, behaviors have to change, and communication needs intensify. Not everyone may be completely on board with what’s best for the loved one’s successful re-entry into the family. Such adjustments take time for all concerned. But with the love and support of family, the recovering addict has a much better chance at being successful in recovery. Research has proven this time and time again.

On the other hand, if family members are not supportive, or the individual has no family, support has to come from somewhere else. Lack of support of any kind is almost certainly to result in relapse.

Participation in Outside Support Groups

Outside support groups consist primarily of 12-step groups. These include Alcoholics Anonymous, the original 12-step group, and others which formed later and continue to utilize the 12-step concept and philosophy of Alcoholics Anonymous. If there’s a recognized addiction, there’s likely already a 12-step group that’s been formed and is available to help those who struggle to maintain their sobriety.

In addition to 12-step groups for alcohol addiction recovery, there are 12-step groups for various drug or substance addictions: Narcotics Anonymous, Cocaine Anonymous, Crystal Meth Anonymous, and Marijuana Anonymous. There are 12-step groups for process or behavior addictions such as Gamblers Anonymous, Debtors Anonymous, Workaholics Anonymous, Overeaters Anonymous, Sexaholics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous.

Why should participation in a 12-step group be a pillar of recovery? One very basic reason is that recovery is an ongoing journey. It’s not a straight-line path and there are no short-cuts to success. It takes constant management, working the steps, being cognizant of what can cause relapse and taking appropriate action to overcome the temptation to use when cravings and urges recur.

When an individual is in recovery, he or she needs the support, understanding, and encouragement of others who have been or are now going through similar circumstances. They know what it feels like to be awakened in the middle of the night with nightmares, panic attacks, anxiety, or overwhelming cravings and urges. They’ve been in situations where they feel ill-equipped to handle stresses and triggers that may precipitate relapse. They’ve had to figure out their way through the minefield of hundreds of daily decisions (should I take a different way home from work, what should I say to my friend who wants me to join him for a drink after work, am I taking too much on my plate so soon after treatment, and so on) and can offer the benefit of their own experiences. What worked for them may work for the newcomer. Or it may be something that can be adapted to better fit the newcomer’s particular circumstances.

In any case, being with and listening to what others in recovery have to say, just having the recognition that these are people just like me who are genuinely working their recovery, is one of the best things that anyone who’s serious about staying sober can do. It’s a true pillar of recovery.

• Working with a Sponsor – Besides the interaction with other 12-step group members, it’s critically important that those new to recovery find a sponsor that will work with them on the steps. The sponsor is someone who has committed to being available to the newcomer and is the first one that should be called whenever there’s a problem working the steps, when a crisis occurs that may threaten to derail sobriety, when there are anxieties or concerns about doing the right thing to maintain recovery. At first, newcomers may select a temporary sponsor. Later on, they may transition to a more permanent sponsor. A sponsor is not a counselor, however, and does not take the place of or fulfill the role of a counselor – nor should they be asked to do so.

While we’re on the subject of 12-step support groups and how they’re a mainstay of successful recovery, it’s important to note that there are numerous 12-step groups for the family members and loved ones of those in recovery. Since addiction is a family disease, just because the addict has gone through treatment and the family members may have gone to family therapy doesn’t mean that everything will always go smoothly. It’s tough learning how to interact with someone in recovery. Besides behavior changes, there are also deep-seated emotional wounds to heal. Talking things out in groups comprised of other friends and family members of loved ones overcoming addiction helps.

These groups include, but are not limited to: Al-Anon/Alateen (the family component of Alcoholics Anonymous), Nar-Anon Family Group (affiliated with Narcotics Anonymous), Gam-Anon, Families Anonymous, Co-Anon, Adult Children of Alcoholics (ACA), Codependents of Sex Addicts (COSA), and S-Anon Family Group.

Ongoing Therapy or Counseling

Following treatment for addiction, many new to recovery feel that they haven’t had enough time or practice utilizing the strategies and techniques they learned during treatment. For many recovering addicts, continuing care or aftercare is a part of their overall treatment program. This consists of continuing access to individual and/or group counseling, help with developing or refining an effective relapse prevention program, assistance with developing and working on long-term goals, and help in any area that’s causing distress to the person in recovery.

Private counseling or therapy is also available.

There are times when those in recovery relapse. Following relapse, it may be necessary for the individual to return to treatment, or increase counseling sessions, to get back on track to sobriety. Again, recovery isn’t a straight-line process. For some individuals, it’s a lot of back and forth. Some people need to go through treatment multiple times before they’re able to be successful in recovery.

Care of the Self

In recovery, it’s important that the individual take good care of him or herself. This means ensuring that they get adequate sleep each night, that they eat well-balanced and nutritious meals, and that they get plenty of exercise. If the doctor has prescribed medication, either to help counter anxiety or depression or inability to sleep or to assist in healing or managing another medical condition, it’s important that the person in recovery continue to take the medication as prescribed. Report any side effects to the doctor so that the medication may be modified, changed, or eliminated, as required. Some psychotherapeutics for depression or anxiety, for example, must be taken for some period of time before any improvements begin to show up. Discontinuing or switching medications too soon can prove counter-productive.

Taking care of the self also means that the person needs to moderate and balance daily stress and obligations, not take on too much responsibility too soon, strive for emotional stability, and pay attention to the need for spiritual enrichment.
Having a daily schedule certainly helps those new to recovery to better manage their day-to-day lives, especially during the first 90 days of recovery when things tend to be most hectic, when the individual is most vulnerable and uncertain.
Adhering to a schedule also provides a sense of relief. Instead of worrying or wondering what to do next, it’s right there on the schedule to see and mark off as completed. It’s one less stressor that the person in recovery has to think about (as in, did I remember to take my anxiety medication, or where is the meeting location for my new 12-step group, etc.).
Time management is also an effective tool in early recovery. Managing time is part of being able to make and keep schedules. It’s also important to factor in the time to play, to read, to meditate, pray, exercise, laugh, be with friends or family, and write in journals.

Addiction recovery experts say that it’s wise to remember the following: Don’t allow yourself to get too hungry, tired, angry, or lonely. That’s because these are the times when you’re most vulnerable to relapse. When you’re ignoring what’s going on with your body and your emotions, you’re putting yourself at risk to succumbing to stressors and triggers and cravings and urges. It’s too easy to tell yourself you’ll just have one drink to take off the edge, or one swing by the casinos couldn’t hurt – after all, it’ll relax you. But giving into these thoughts is always a mistake. It won’t stop at just a single drink, and you can’t just breeze through the casino – like that would ever work now that you know about your addiction.

Learning How to Be Resilient

Ever wonder why some recovering addicts seem to go through a lot of stress and adversity and still maintain their sobriety? How is it, you may ask, that one person can have so much happen in his or her life following return from treatment for addiction – one crisis after another – and still be able to keep on the path of recovery? The same things happening to another individual may cause immediate relapse.

Many experts in the field of addiction recovery say the answer is resiliency. Let’s use the analogy of trees, a sapling versus a mature tree. Think of the sapling that is able to bend in the wind and quickly return to its former shape once the gale has passed. Now think of the mature tree that’s shallowly planted and is broken in two by the force of that same wind. It’s easy to see where resiliency allows the sapling to withstand the force and the lack of resiliency destroys the mature tree.
Resilience has been defined as the universal capacity that an individual uses to prevent, minimize, or overcome the effects of adversity. Resilience thus reflects a person’s strengths as protective factors and assets for positive development – as in the resiliency to bounce back from crises or setbacks that occur in recovery.

Developing resiliency gives the individual in recovery another effective tool to be able to withstand crises, stresses, cravings and urges that appear out of the blue. Being able to bounce back, not internalizing guilt or blame, and being able to see where progress has been made and moving forward toward recovery goals is not only a good idea, it’s almost a requirement for effective and ongoing recovery.

Live in the Present and Create a Plan for the Future

The foundations or pillars of recovery work best when the individual lives fully in the present, while creating a plan for the future. Achieving a mind/body/spirit balance, maintaining a positive outlook, and finding joy in everyday life also impact the individual’s recovery.

In short, recovery consists of many different aspects. It is ongoing, filled with daily opportunities and challenges, instances where learning and growth and hope and love can all occur. And, while recovery is personal and unique to each individual, no one recovers alone.

Based on the findings from their new study, the researchers found that hundreds of deaths caused by pancreatitis, liver cirrhosis, gastric disease, cardiovascular disease, and cancers from chronic heavy alcohol consumption could be avoided by increasing the state alcohol tax. Their study—the first to compare state legislation on alcohol tax and alcohol-related deaths among the population—will be available in the November issue of the scientific journal Alcoholism: Clinical & Experimental Research.

Lead researchers Dr. Mildred Maldonado-Molina and Dr. Alexander Wagenaar compared the changes made to alcohol tax rates in the state of Florida from January 1969 to December 2004 with Floridian deaths caused by alcohol-related diseases during this time.

According to the researchers, the last time Florida’s state legislature increased the alcohol tax was in 1983, when the per gallon tax on beer rose from $0.40 to $0.48, the per gallon tax on wine rose from $1.75 to $2.25, and the per gallon tax on spirits rose from $4.75 to $6.50. These state taxes are still in effect today—a quarter of the equivalent of what Florida’s alcohol tax was during the 1960s. The decrease in the tax rate was caused by inflation over the past few decades, but the state legislation has not made any changes for several years to adjust the rate against the value of the U.S. dollar.

Then the researchers examined 432 monthly observations of mortality among the Florida population over the 36-year period. Researchers ascertained causes of death from the U.S. National Vital Statistics System of the National Center for Health Statistics and available information on Floridian death certificates. Researchers controlled such variables as non-alcohol-related deaths, changing economic conditions, as well as comparison to other states’ rates of alcohol-related deaths to ensure that deaths included in the study were specific to alcohol tax effects. The researchers left out deaths caused by vehicular accidents, crime, and violence associated with alcohol use from the study.

As a result, researchers found that significant decreases in mortality related to chronic heavy alcohol use were linked to legislative increases in the state alcohol tax. Increases of 10% in Florida’s alcohol tax caused a 2.2% reduction in alcohol-related deaths, showing a significant decline in the frequency of deaths among the size of the population. By adjusting the Florida real alcohol tax to parallel the tax rate from 1983, researchers estimate that almost 600 to 800 lives per year could be saved from alcohol-related diseases. If the real alcohol tax rate were adjusted to the 1960s levels, almost 1,500 deaths per year could be prevented.

Had the researchers included other alcohol-related causes of death other than alcohol diseases in their study, the relationship between state legislation on alcohol tax policy and mortality rate would have been even stronger.

Source: Medical News Today, Death Rates Among Chronic Heavy Drinkers Can Be Reduced By Alcohol Taxes, August 10, 2010