The Functioning Addict, Does It Exist?

The path to healing an addict often takes many routes. But the destination and the focus on that destination is one of the most important parts of recovering from drug and alcohol addiction. That destination is recovery.

 

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The Functional Addict. The

A difficult aspect if not the most difficult aspect of addiction is the individual who seems to have everything in their life together, with the exception of their drug and alcohol use. The man providing for his family, he has all the things that society would see as a success but yet he is addicted to drugs and or alcohol. The mother who has always kept it together, the kids are well cared for and always on time and dressed well, but the minute they are out of her sight she reaches for a handful of pills, or a bottle of alcohol.

Addiction is an equal opportunity destroyer of lives. There was a man I met many years ago, singing Sam was his name and he would share this every time I would meet him,

“Silk sheets or city streets park avenue or park bench”

Alcohol is an equal opportunity destroyer of lives.  There are many people today’s world and again to the outside world look like they are functioning yet inside they are dying. Pitiful and incomprehensible demoralization doesn’t necessarily have anything to do with living on the streets or drinking out of brown paper bag.

There are many people today who though their lives look from the outside being together. They are in fact dying as a result of the disease of addiction.  And it’s their family and friends are the people who see it.  The signs of a functioning addict.  Many of them in denial not wanting to address to it.  There was a commercial done a number of years ago that was done about addiction.  There wasn’t any speaking in the course of the commercial. There was just a family, and they looked much put together but there was an elephant walking around the house. Often addiction is precisely that. No one wants to address it, because no one wants to rock the boat especially if life has the appearance of everything is fine.  But those that care about the suffering addict know that it is not.

The individual must make the choice, if they wish to get sober if they wish to get clean, if they wish to change.  But that does not mean that the people that care can’t take the action on their own.  There are many wonderful programs and many caring professionals who can help you deal with your feelings about the suffering alcoholic addict and as well if you are someone who is successful, and you know that drugs and alcohol are killing you we can help you as well.

My Child Is An Addict, Here Are My Fears…

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When you come to the realization that “my child is an addict”, there probably is no greater fear that a parent has than that call in the middle of the night or worse yet, the knock on the door. If you have a loved one or a child whose suffering and has been suffering, from the disease of addiction, especially if they have already been to a rehab and left and resumed their old lives, you know the frustration that comes from being a parent of an addict.

You know what I am talking about.  If they survive and they wind up in jail or a hospital.  The phone rings in the middle of the night or it’s the knock on the door from the police officer or some official.

There is no greater fear for the parent or loved one of the suffering addict and alcoholic than that phone call or knock on the door. Whether your loved one gets drug counseling help will ultimately be up to them.  You will do everything you can to do to help because you love them.

But as the parent or loved one of an addict, you also need help.  We can help you with this as well, we have drug counseling professionals who are here, who can help you deal with the pain and the pitiful and incomprehensible demoralization of having a loved one or child who suffers from the disease of addiction and refuses to get help or get well. We can be there for you and direct you in ways that will give you the piece of heart to deal with this terrible problem.

Alcohol & Drug Addictions

The path to healing often takes many routes. But the destination and the focus on that destination is one of the most important parts of recovering from drug and alcohol addiction. That destination is recovery.

Treating Heroin and Other Opioid Addiction with Medications

Treating Addiction With Vivitrol And Other Medications

There are different opinions on the subject of recovering from addiction and treating heroin and other opioid dependencies with medications. With the recent death of Philip Seymore Hoffman, the topic of heroin addiction has been getting a lot of attention in the news. In this article I share my opinions about using medications to treat chemical dependency to heroin and other opioids.

What is an “Opioid”

The term “opioid” describes a set of street drugs and medications that are derived from the opium plant – pictured above. The most well known opioid street drug is heroin. Opioid medications are used for the treatment of pain. Examples of well known opioid medications include Morphine, Dilaudid, Vicodin, Percocet, and Oxycontin. Over the past few decades, the abuse of opioid medications has sky-rocketed. In 2008 alone, over 5 million Americans abused pain killers. The field of medicine is beginning to put more and more restrictions on prescribing opioid medications, and this is causing the street price of these medications to go up. As these medications become more and more expensive, people are turning to using heroin which is a cheaper option. We can argue that opioid dependence and addiction is quickly becoming an epidemic in the United States.

What does “Opioid Dependence” Mean

A person develops opioid dependence when he or she cannot stop using opioids. Dependence is both emotional and chemical, meaning that the dependent person struggles with difficult feelings as well as physical withdrawal symptoms when that person tries to stop using the substance. Physical withdrawal symptoms in opioid dependence are extremely uncomfortable and include racing heart, nausea, vomiting, diarrhea, sweating, restlessness, yawning, anxiety, and pain.

Example of Opioid Dependence

Opioid dependence can occur with or without opioid addiction. An example of opioid dependence would be a man who has had several complicated surgeries after a car accident, and who has been on high doses of Vicodin for pain for the past few months. If his pain medications were stopped abruptly, he would most likely go through severe withdrawals. He will need to be weaned off the medications gradually, or go through a detoxification in order to stop his medications. He is chemically dependent on opioids.

Example of Opioid Addiction

Imagine a scenario in which the man in the above example begins to take more Vicodin than was prescribed to him by the doctors. He gets to a point where he wants the pills and craves them whether or not he is in any pain. He begins to run out of the Vicodin, and starts going to different doctors to get more prescriptions. He hides his medication use from his family and feels guilty about it. When doctors refuse to give him more prescriptions, he starts buying Vicodin, Percocet, Oxycontin, and Norco from illegal sources. He tries several times to stop taking the medication, but each time he goes back to using it again. We can safely say that this man is now addicted to the opioids.

Medications Used to Treat Opioid Dependence

Stopping the use of opioids “cold turkey” is really difficult because of the severity of the withdrawal symptoms. Withdrawal symptoms start around twelve hours after the last use of the drug, and are quite severe at twenty four hours after the last use. Many of my patients tell me that they ended up using the drug again because they could not bear the withdrawal symptoms. Even if someone manages to tolerate the initial withdrawals that they experience in the first 1-3 days of not using, they will experience severe muscle and bone pains within about a week after their last use of the drugs.

There are medical choices for stopping the use of opioids. Methadone is one option in which a recovering individual would go to a clinic on a daily basis and get a dose of Methadone. Methadone is itself an opioid medication, and it stops the withdrawal symptoms. People do develop chemical dependency on Methadone, and will have to be weaned off of it gradually. Another newer option is the use of Buprenorphine either by itself (brand name Subutex) or in combination with other medications (brand name Suboxone). Chemical dependency to Buprenorphine also occurs, and people will have to be weaned off of it as well. The reasoning behind using these medications for management of the addiction is that they don’t give the patient the same “high” as the drug does, and therefore have a much lower potential for being abused. Naloxone and Naltrexone are older options that are rarely used any more. Vivitrol is an injection of naltrexone that is newest option in the treatment of opioid addiction. People who take these medications can usually function well and go back to living their daily lives.

A brand new study published in February of 2014 looks at the effectiveness of treatment with Buprenorphine. In this study, data available from different original studies ranging from 1995 until 2012 were analyzed. Based on the data available, it was concluded that treatment of opioid dependence with either Methadone or Buprenorphine show better outcomes than quitting the opioid cold turkey.

Buprenorphine

In my practice, I treat opioid dependence with Buprenorphine. The brand name I mostly use is Suboxone, and I rarely use Subutex. In my experience, Suboxone has been incredibly helpful in the process of helping a person to stop using opioids with very little withdrawal symptoms. This process is very commonly known as “detoxification,” or “detox” for short. I use Suboxone for both the detox process, and sometimes as “maintenance,” depending on my evaluation of each patient.

The detoxification process with Buprenorphine takes anywhere from five to ten days. Consider the case of a woman who has been taking Vicodin for headaches for the past two years, and is now taking about ten to twenty Vicodin pills a day. She would start detoxification by waiting anywhere from twelve to twenty four hours after taking her last Vicodin pill(s). We would wait until she is in “moderate to severe” withdrawal and then give her the first Buprenorphine dose. Usually, relief from withdrawal symptoms comes quickly within five to ten minutes after taking the medication. We would then give her the medication at regular times throughout the next five to ten days, and expect that each day she would have less withdrawal symptoms. After the detoxification phase is over, we would talk about maintenance.

Advantages of using Buprenorphine are numerous. Patients usually can tolerate the medication well, and they manage to stop their use of opioids with much less difficulty than trying to stop cold-turkey. In the addiction world, opioid withdrawal is so severe that the process of using more opioids to stop the withdrawal symptoms is referred to as “getting well.” I find it very ironic that the process of drug use is known as getting well, since there is nothing healthy about abusing opioids. Buprenorphine can keep away most of the withdrawal symptoms, without giving the individual a “high” that normally comes with abusing opioids. Although many rehabilitation facilities have adopted the use of Buprenorphine in the detox process, there is still a lot of resistance to using Buprenorphine as a means to maintain sobriety. There is a belief that one is not truly sober while they are using Buprenorphine. One of the reasons behind this belief is the fact that Buprenorphine itself has withdrawal symptoms when patients decide to stop taking the medication.

I prefer work with each patient individually to understand what his or her needs are rather than making a blanket statement about what sobriety means. For example, for a patient that has had a short term dependence on opioids, is trying to quit it for the first time, and does not have other complicating factors, I usually suggest using Buprenorphine for managing the withdrawal symptoms, and slowly wean him or her off of the medication. On the other hand, if I have a patient who has been using a lot of opioids over a long period of time, has tried several times to quit the drugs and has relapsed every time, has resorted to injecting the drugs intravenously (IV), and most importantly, if he or she has a history of overdosing on the drug, then I discuss use of Buprenorphine as a maintenance tool. Either way, it is important to talk to each person individually and try to come up with a treatment plan that works for him or her. Generalizations are usually not a good idea when it comes to such a life-threatening disease.

Buprenorphine use has its disadvantages as well. When a patient is on Buprenorphine, he or she cannot get a high from using opioid drugs. Some people keep using more and more drugs to get the high, and end up overdosing. Another disadvantage of using Buprenorphine is that come patients just plan their relapses ahead of time, and stop taking Buprenorphine a day or two before their planned relapse.

The disadvantages listed above are cause for serious concern, and are the reason why Buprenorphine treatment should be closely monitored by an experienced physician. Patients that relapse and continue using opioids while on Buprenorphine are probably not good candidates for the medication. I don’t see any point in prescribing Buprenorphine for someone who is not yet committed to becoming sober.

Methadone

The process of detoxification using Methadone is similar to the process of using Buprenorphine. The person stops using their drug, and when in withdrawal, begins taking Methadone as prescribed by his or her physician. Methadone maintenance has been around for a while, and it has been known to have positive outcomes.

Methadone maintenance has the same disadvantage as Buprenorphine in that people can just plan their relapses by not taking the medication. Additionally, being on Methadone maintenance requires the person in treatment to go to a clinic on a daily basis. Some also argue that the use of Methadone itself gives the user a high, and therefore is not compatible with sobriety. I believe that using either Buprenorphine or Methadone for maintenance of sobriety is acceptable. In my practice, I use Buprenorphine.

Vivitrol

A relatively newer alternative to Methadone and Buprenorphine comes in the form of Vivitrol (Naltrexone) injections. This is a shot that is given once a month. Vivitrol has been shown to prevent the symptoms of craving, and to prevent the individual from getting a high if he or she uses opioids while on Vivitrol. There is a risk of overdosing on opioid drugs while on Vivitrol as well as Buprenorphine, and there are less studies available for it. My patients, however, like the convenience of once a month injections. They also like the fact that once injected, the medication stays in their bodies for a month, and they cannot choose to skip a dose as easily as they can with Suboxone.

Summary

This table summarizes the medications discussed above.

Brand Name Generic Component (s) Utilized in My Practice Route of Administration Frequency of Administration Patient Can Become Dependent
Methadone Methadone No Drink Liquid Once a Day Yes
Subutex Buprenorphine Yes Dissolve Tablet Under Tongue One or More Times Daily Yes
Suboxone Buprenorphine plus Naloxone Yes Dissolve Film Strip Under Tongue One or More Times Daily Yes
Vivitrol Naltrexone Yes Injection Into Muscle Once a Month No

Conclusions

Studies from 1995 until recently have pointed out the benefits of using medications to manage opioid addiction. Medications have been shown to be useful in both detoxification off of the drugs, and maintenance of sobriety. Although benefits of these medications have been shown, they are definitely not for everyone. They are also not enough by themselves. People who are most dedicated to their sobriety will “work a program” on a daily basis. Addiction is a complicated disease with a heavy psychological component. Although medications can be helpful in management of opioid addiction, achieving and maintaining sobriety requires life-long dedication and hard work.

What does the Term “The Addict Brain” mean?

Addict Brain

This article attempts the task of defining “The Addict Brain.” Please note that addiction is a very broad subject which is way beyond the scope of this one article. Here we will examine and try to understand the function of the addict brain.

If you or someone you know is suffering from addiction, click here to take a look at our recovery program.

In our society we use the term “addict” or “addicted” very loosely. We say things such as “I’m addicted to Wordplay,” or “my aunt is so addicted to the Oprah show,” and so on. If we were to use the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is used by mental health professionals, then an addict would be defined as a person who engages in an activity with certain behavioral traits. The activity is not necessarily drinking alcohol, doing drugs, or a combination of both. Addiction can also include behaviors such as eating, playing video games, watching certain programs on TV, browsing the internet, exercising, and an endless variety of other habits. The traits of an addict are:

  1. building “tolerance” to the activity, so that more and more of it is required to feel the same effect
  2. developing “withdrawal,” such that when the person tries to stop the activity, the body goes through a series of unpleasant symptoms and demands that the person re-engage as soon as possible
  3. larger and/or longer quantities of the activity are required by the body over time
  4. the person desires to quit the activity, and tries repeatedly and unsuccessfully to quit
  5. a lot of time is spent on engaging in or preparing for the activity
  6. other social and work-related activities in the life of the person are given up for the sake of the addiction
  7. the person continues to engage in the activity regardless of the consequences,whether they are health related, or related to the social or work life

Given this definition, we can describe the “addict brain.” Other terms that have the same meaning are the “addicted brain,” or the “alchie” brain. The last term is used in the Alcoholics Anonymous (AA) program. In AA, the opposite of an “alchie” brain is a “normie” brain. The phrase “addict brain” is based on a model of thinking in which addiction is considered a disease, like cancer or diabetes. In this model of thinking, the addict is suffering from a disease that is out of his or her control and needs help to put the disease in remission or “recovery,” just as a person battling with cancer would need treatment. I use the example of cancer because addiction is equally – if not more – devastating to the affected person as well as his or her loved ones. I personally agree with this disease approach to addiction. I have treated addiction for many years now, and I have yet to meet a person that decided consciously to become an addict. In cancer, a mutated cell escapes the body’s defenses and begins to multiply without regulation. In addiction, the addict brain escapes the brain’s powers of logic and common sense and seeks the addictive activity at all costs.

The development of the addict brain is caused by the brain’s response to rewarding stimuli. The brain of every human being has a center at which rewards are recognized. The center is there to detect situations that are pleasant to the body, and to encourage the body to place itself in those situations again. Consider the case of seven-year-old Charlie, who gets an A in his math test. His teacher is very proud and tells his parents how well he did. His parents reward him by putting his test up on the refrigerator to celebrate his accomplishment. Charlie enjoys the reward and is likely to try to get more A’s in his tests.

The reward system in an addict brain has gone awry. The best way to understand the addict brain is through a series of examples that demonstrate it.

Consider Jane, who at the age of 16 drinks her first beer. She really likes how it feels, so the brain considers this a reward. For Jane, she may react to this in one of two ways; she could enjoy one or two drinks socially for the rest of her life and never take it further than that. Alternatively, Jane may decide that she wants to experience the feeling more often. Over the years, she drinks more and more beer and then discovers that hard liquor feels even “better.” She may experience consequences such as blackouts, hangovers, or even arrests for driving under the influence. She may realize that her drinking has become a problem, but her addict brain makes all kinds of excuses for her to drink. She would get arrested for a DUI and spend the night in jail. The next day, her addict brain convinces her that she is a loser, so she may as well drink some more to drown the shame. She may go to court for her DUI and find out that she has been given another chance and will not lose her license, so her addict brain will tell her that this is an occasion to celebrate with a drink. Her kids may do very well in school, which require champagne (multiple bottles followed by Vodka), or they may become criminals, which will require Vodka to “numb out.” The reward system in her brain is rewarded by one and only one thing: alcohol. Jane is in trouble; her addict brain has taken control. Her husband may leave her and that would put her on a “binge” of drinking non-stop for a year. The court may give full custody of her children to her ex-husband because she is deemed unfit to take care of them. Her addict brain will tell her that she cannot handle this loss without drinking. There are only two ways to end this cycle: Jane will either die, or she will need to get serious help. Even if Jane checks into a rehab center for the sake of her children, she may relapse several times, and will need to understand her addict brain and learn not to listen to it for the rest of her life. That is why we never call an addict a “recovered” addict. Instead, we call him or her a “recovering” addict because once one is addicted, he or she is addicted for life.

Unfortunately, the addict brain can be even more manipulative. For example, Joe, who has been using cocaine and alcohol all his life, may decide to quit them and will successfully do so, only to find himself 5 years later using marijuana and crystal meth. This is called “cross-addiction”, and it occurs when the brain replaces one addiction with another. The addict brain, once it figures out that it won’t get a certain reward no matter how it manipulates the person, will seek another substance or activity to fixate on, and get the rewards that way. This is why it is so important for recovering addicts to remain vigilant in life and try not to engage in any addictive behavior.

The addict brain also has a tendency to block out all evidence that support the idea that the person is an addict or needs help. For example, Joe may be doing some drugs regularly. He is convinced that it is his choice to do drugs and that he can stop at any time. If Joe’s friends or family try to point out to him that he is an addict, he will get irritated or angry with them, and he will shut them out. The harder the family tries to come between Joe and his reward system, the more the addict brain convinces Joe that his familyis against him or even out to get him. The relationship of an addict with his or her family is very complicated because in many cases, the addict becomes financially dependent on others for the support of the drug habit. In these cases, the addict will become extremely manipulative to keep the family around. I’ve seen cases where an addict threatens his or her spouse with suicide unless the spouse supplies the addict with the substance. They ask family for money in many different ways, and if they are refused, they may even resort to stealing from their own loved ones. The addict brain will justify any act that will give it the reward it needs. Even when Joe begins to understand that he has a problem, and tries to address it, the addict brain will resort to making up stories such as “I’ll quit this Christmas,” or “this one will be my last fix before I stop,” or a whole slew of other stories that will keep Joe using.

Families of addicts often become prisoners to the manipulative behavior of the addict. It is heartbreaking to witness this as a psychiatrist. I have had parents ask me what they are supposed to do, and they just don’t want to hear that there is nothing they can do. The only choices the family members have are to: stay in contact with the addict and accept or even support their addictive activity; stay in contact with the addict with strict limits and a clear message that the addict is not supported by them in anyway in continuing the activity; or completely cutting out the addict and letting him know that he is welcome back into the family only after establishing (with proof) a certain period of sobriety.

In medical school I had the gift of doing a two week rotation in drug and alcohol addiction. This was done by participating in a rehab center as a patient. Although we didn’t sleep there overnight, we participated in all the daily activities. This rotation was life changing for me and I truly understood how the addict brain works and how the addict becomes a slave to his or her addiction. While in residency, I had a patient in his 50′s who was admitted to the medical unit because of health complications that were caused by years of using IV heroin and other drugs. I contacted his family members to let them know that the patient was incredibly sick and that he could die any day. The family members each informed me that they had long ago decided that they could not handle the patient’s disease any more, and had cut all contact with him. I never judged the family; the stories they had of how they had been manipulated, abused, and subjected to theft by my patient were endless and heartbreaking. My patient never had a visitor while he was in the hospital, and ultimately, he died alone.

During a rotation in medical school we also had a patient who had destroyed her liver by the time she was in her mid-thirties. She was put on a liver transplant list, and needed to stay off of alcohol and all drugs for six months before she would be considered for a transplant. Seven months into her sobriety, she was called in to be tested for transplantation of a liver that had become available. She went in and the tests revealed that the liver was not a good match for her. Her addict brain used that as an excuse to get her to go drink again. Her liver could not handle the drinks, and by the time she got into the hospital, she was in liver failure. She died within three days.

I currently have a young patient who is the poster boy for recovery. He has done very well, and continues to work on his recovery on a daily basis. He loves video games and yet is very vigilant to not play them in an addictive manner. He gives himself strict time limitations and sticks to them. He told me yesterday about how he met a young woman and had a few fun weeks with her. Although it did not work out, he dealt with it. Now he realizes that his addict brain is seeking the rewards of dating and is pressing him urgently to meet someone else. He is consciously deciding to give himself a break from trying to meet another woman. He understands his addict brain and is constantly on the watch for the pitfalls that are everywhere.

I have another recovering patient who became addicted to pain medications because of what was prescribed to her by her physicians. She has a very serious medical illness, requiring multiple surgeries. She also has a very firm and clear understanding of her addict brain, so she is very adamant about how her pain is controlled by her surgeons, and what analgesics are used. I have had the pleasure – mixed with compassionate pain – of watching her go through horrendous procedures with minimal pain control because she would rather deal with insurmountable physical pain rather than having to deal with a relapse on pain medications.

The above two are examples of the everyday heroes I see in my practice, and I am in awe and respect of them. It is a fact, however, that for every one of these recovering stories, there are as many, or many more, relapse stories. The addict brain is as deadly and as hard to recover from as the deadliest of cancers. In both cases you don’t know if someone has truly beaten the disease until they die of another natural cause!

I hope this helps you in understanding the addict brain a bit better. If you have more questions on how someone becomes an addict, or how to deal with a family member that is an addict, please let me know.

Here, for “words to live by,” I will share the Serenity Prayer used in AA and its associated recovery programs. There are many whose lives have been saved by these words:

“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”