Go from Surviving to Thriving

Often times, the people who I support are attempting to fill a parent-sized void with addiction. They have unmet needs from childhood or they’re survivors of trauma. Regardless of the degree of severity, addiction becomes a tool for coping with stressors and unpleasant emotions. Over time, the person develops a relationship to their drug or compulsive behavior of choice and an attachment bond forms. More often than not, this attachment is seen as a source of stability, predictability, and comfort — much like the attachment one expects from healthy parenting.

This is not necessarily bad and, in fact, can be seen as an adaptive survival strategy when a person lacks other tools. Without emotional regulation skills or the bandwidth required for self-reflection, it’s very easy for anyone to turn to problematic coping strategies. However, recovery from addiction is only possible when one cultivates awareness around these attempts to fill a void and responds in an intentional way.

Here are some indications of maladaptive coping:

  • Feelings of shame following the attempt to cope
    • I used ketamine to escape overwhelming feelings of rage but I’ve been trying to abstain from using it.
  • Interruptions to work and relationships
    • A fear of being judged by my partner leads me to drink in secret to cope with trauma symptoms
  • Need for more coping due to the intervention
    • After drinking too much to cope with loneliness, I feel hungover and turn to compulsive sexual behaviors for comfort.

The need to manage feelings of rage, loneliness, and anxiety is real and healthy. Your need for coping is not the problem, it’s the maladaptive strategies being implemented. What’s one small thing you can do today to become more aware of your emotional and relational needs?

  • Meditate for 5 minutes
  • Jot down all your feelings at the end of the day
  • Journal for 5 minutes before bed
  • Take 5 minutes to reflect on feelings of anger, resentment, or betrayal

The difference between surviving and thriving lies in the choice to make intentional, thoughtful, and empowered choices to cope versus impulsive, desperate, and destructive ones. Thriving means living your best life, being your best self, and managing your mental health despite the challenges life throws your way. It doesn’t mean life is perfect or easy, but it does mean that you feel confident, competent, and willing to tackle stress, pain, and urges to engage in problematic drug use.

Let us know in the comments how you cultivate awareness around your needs. We’d also love to hear about the healthy coping strategies you implement for relapse prevention.

Rave Responsibly, My Friends

night time burning man scene with a neon VW bus , lasers, and dancersWith Burning Man just around the corner, many people have been inquiring about the responsible use of various drugs, including psychedelics and MDMA. So, here are some tips on maximizing the *awesome* in your psychonauting adventure while minimizing the *bleh*.

Everyone’s favorite party girl will want at least one playa date this year, so here’s how to hang with Molly. 3,4-methylenedioxy-methamphetamine metabolizes into free radical compounds which may cause neurotoxicity. Check out this article if you want to dig deeper into the science.

To reduce free radicals load up on antioxidants. Vitamin C is a great one and so is n-acetylcystate (NAC). A psychiatric nurse practitioner friend recommends the following: 500mg of Vit C and 600-1200mg of NAC an hour before, an hour or two into the experience, and in the hour or so afterwards. Taking it the next day won’t hurt, either.

A favorite post-dose among ravers is 5HTP (5-Hydroxytryptophan). The thing is, our guts break it down to 5HT which can’t cross the blood brain barrier so taking a supplement is moot. However, you can load up on tryptophan in the days leading up. Vegetarian-friendly food options include chia seeds and pepitas (pumpkin seeds) and omnivores can load up on turkey sandwiches.

The best thing you can do for your brain after a night of partying is sleep. Melatonin can help and if you have access to lorazepam it can come in handy in multiple scenarios (keep reading!).

For more info about dosage, warnings signs of overdose, and contraindications check out rollsafe.org

Now on to everyone’s favorite tool for exploring the edges of consciousness: psychedelics. There isn’t much to do in terms of pre- and post- dosing, however there is a lot that can impact the quality of your experience.

Remember drug, set, setting. Consider the effects of the drug you are taking, the chaotic, dusty, bug-infested environment you will be inhabiting, and your current state of mind. If you are feeling funky or freaked out by the environment consider taking a different substance (perhaps a dissociative?) or skipping mind alteration altogether.

Setting intention and having ritual before dosing with psychedelics can really make a difference! Make eye contact with your fellow psychonauts before dosing. Take a moment to reflect on your desires for the experience. Maybe you just want to roll face. That’s cool. Be intentional about it!

It’s a good idea to have someone in the group who is not on psychedelics so they can step in if someone starts to have a bad trip. Check out tripsafe.org for info on tripping responsibly and tips on how to help when someone is not having a good time. Lorazepam is helpful for bringing someone out of a bad trip. Alternatively, you can wrap the person in a heavy blanket. The Zendo Project will be at 2:45 & Arcade and 9:15 & Donniker if you or someone you know is having a difficult experience.

Last, but certainly not least, I present you with this amazing chart on drug combinations created by tripsit.me. I highly recommend their app available on Google play.

Remember to be safe, take care of each other, and have an absolute blast!

 

Disclaimer: Always consult with a medical professional before taking drugs, especially if you are on medication or have a physical or mental illness. Remember the possession of drugs is illegal and by no means does this site recommend that you engage in the activities described here. The information provided here is for educational purposes only and it is your responsibility to decide whether or not to assume the risks associated with consuming drugs.

Photo credit: Joe Abbruscato

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It’s the most wonderful time for a beer: 10 tips to control holiday drinking

martini glass with christmas tree ornaments

What does alcohol have to do with Christmas? One makes the other bearable.

The holidays are a time of festivities, joy, family, and friends. It’s also a time of stress, material consumption, and lots of drinking. As someone anonymously put it, “What does alcohol have to do with Christmas? One makes the other bearable.” Whether at the company party or over dinner with the family, the holiday season introduces many opportunities to drink. In fact, according to the Distilled Spirits Council, the distilled spirits industry makes more than 25% of its profits between Thanksgiving and New Years.

For some, the added stress of the holidays or painful memories about family can trigger compulsive drinking. For those who already engage in problematic drinking, the stress can worsen drinking behaviors.

Abstinence from all alcoholic beverages may be the best strategy. But for those who don’t want to abstain or who simply want to be mindful of how much alcohol they consume, moderation is key.

Tips for moderating:

  1. Drink on a full stomach. Pair your wine or beer with delicious cheeses. Don’t forget snacks when planning a cocktail party. Plan for dinner before heading to the company holiday party.
  2. Plan your night before you start drinking. Think about how many hours you will be partying and set a limit for how many drinks you’d like to consume. Remember it takes approximately one hour to metabolize one drink. And one drink is probably less than you think: a 12 oz beer, a 5 oz glass of wine, or 1.5 oz of 80 proof liquor. Tell someone supportive about your plan—a spouse, friend, coworker, or family member. Ask them to check in with you halfway through the night to help keep you accountable.
  3. Count your drinks. If you’re drinking beer, keep the bottle caps in your pocket or purse to help you keep count. Keep pennies in your left pocket and move one over to your right pocket each time you have a cocktail. Send yourself a text each time you get a new drink.
  4. Drink a full glass of water between each alcoholic beverage. Keep yourself hydrated and keep hangovers at bay!
  5. Dress up a non-alcoholic beverage like a cocktail. Cranberry juice with a lime looks just like a Cape Cod. Same goes for Sprite and soda water. If you’re drinking beer, refill your bottle with water. No one will know the difference! Here are some tips from bartender Mike Hagan.
  6. Lighten up! Turn that glass of wine into a spritzer with some soda water. Go for that 3% beer! Instead of a shot of tequila, how about adding some ice and ginger ale? If you start with a cocktail, consider switching to beer. The lower alcohol content will be absorbed more slowly.
  7. Arrive late to the event or leave early. Seeing others sloshed may motivate you to moderate. And it will likely be very entertaining! Make an intention to mingle for 30 minutes before you order a drink at the bar. Set the tone for the night.
  8. Sip, don’t gulp your drink. Go ahead, get snobby about it. Describe the notes of that IPA on your nose (“Ah, yes. It smells of a warm summer day frolicking in the grass.”)  and on your palette (“And tastes of toasty, roasted hops.”) Make believe you have a blog about artisanal cocktails and write a mental review of each drink you have. Be mindful about the experience the drink is creating for you. Is it sweet or sour? Cold or room temperature? Does it conjure memories?
  9. Pay attention to self-talk. Are you trying to convince yourself to drink more because “it’s the holidays” and you “deserve it?” Check in with yourself before each drink. Do you really want another one? Will it get in the way of any plans you’ve made for the rest of the evening or tomorrow?
  10. Don’t forget to have fun! Focus on your friends, family, coworkers, and the setting. Let the experience engross you. Dance!

This should go without saying, but please do not drink and drive. It is estimated that 1,200 people will die this holiday season due to drunk or buzzed driving. Always designate a sober driver or make other arrangements to get home after a night of drinking.

If you think you have a drinking problem or are struggling with moderation, there are many ways to get help. The National Institute of Alcohol Abuse and Alcoholism offers information and resources on their website. Find a therapist who specializes in evaluating and treating substance abuse to understand your best treatment option. You can also find support at Alcoholics Anonymous and Moderation Management meetings in your area.

The holidays may be a stressful time, but they are also a wonderful time to share with the people you love—including yourself. Make the most of this time with those you care about. Create an intention to connect with someone over the holiday; that may even be yourself.

Do you have other ideas or strategies for moderating? What has worked for you in the past? How do you manage your drinking over the holidays? Answer in a comment below.

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Why people develop a drug of choice

This is the last installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.

representation of addiction

Drugs and compulsive behaviors are used to cope with a variety of problems.

Drug of choice can say a lot about a person or what they’re coping with. People choose drugs that will best help them cope with underlying problems. Sometimes these problems include severe mental illness. Addiction can occur when drugs or compulsive behaviors are relied upon for alleviation from multiple or serious problems.

Alcohol is often sought out by those who have a hard time expressing themselves, especially if coupled with social anxiety. It makes you feel loose and carefree by releasing GABA and suppressing glutamate in the brain. The soothing and disinhibiting effects are also helpful to people in emotional pain, such as someone suffering from grief.  Sometimes people with trauma histories turn to alcohol to soothe their psychic wounds. People with schizophrenia sometimes use alcohol to quiet auditory hallucinations.

Amphetamines give you a rush of pleasure and boost energy and focus by altering norepinephrine and dopamine in the brain. They may be sought out by someone who is depressed and has been unable to feel pleasure for some time. Improved focus may be sought after by someone with ADHD. Anti-psychotic medication can have dulling and flattening side effects and sometimes people with schizophrenia seek out the alertness and energy of stimulants. Nicotine is used by 95% of people with schizophrenia because of its ability to increase concentration and focus.

Opiates may help someone who is feeling irritable, stressed, or moody by blocking endorphin receptor sites in the brain and increasing feelings of euphoria. People who have experienced trauma or are in significant emotional pain may also turn to opiates to help soothe and forget their painful memories. Traumatized people may also turn to dissociatives for their ability to induce out of body experiences.

Hallucinogens and ecstasy create a sense of connection and feelings of warmth and empathy by altering serotonin and norepinephrine receptor sites.  Someone with anxiety or an inability to feel pleasure may turn to these drugs for comfort.

Recreational and pharmaceutical drugs work on the same systems in the brain. So if your drug use is an attempt to self-medicate an underlying problem, speaking to a trained professional can help you find healthier alternatives to cope.

Photo credit: Marrinc

 

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Neurotransmitters and Addiction

This is the fourth installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.

Drugs act on neurotransmitters to increase, decrease, or alter their release or reuptake.

Drugs act on neurotransmitters to increase, decrease, or alter their release or reuptake.

In the previous installment of this series, we learned that dopamine is responsible for feelings of pleasure and euphoria, but it has other functions as well. And dopamine isn’t the only chemical messenger in the brain.

Dopamine is just one of dozens of neurotransmitters. It is the most well known chemical messenger and is responsible for feelings of pleasure, coordination of movement, and logical thinking. It is responsible for “the rush” one feels when they use a recreational drug and it also influences the addictive potential of a drug. It is released when we do things that are important for survival, like sleeping, eating, and having sex. Dopamine sends the message “That feels good! Do it again!”

Norepinephine is one of the brain’s natural stimulants. It is responsible for increased alertness and focus and is involved with learning and memory processes. Norepinephrine is also involved in the fight or flight response. It signals the release of adrenaline in your body to prepare you for survival in the face of imminent danger. It sends the message “Fight!” or “Run!”

GABA (gamma-aminobutyric acid) is the brain’s Valium. It relaxes the brain by suppressing overexcitement or hyperactivity, while allowing us to remain alert and focused. Low levels of GABA are associated with anxiety and seizure.

Glutamate stimulates various activities throughout the brain. We don’t know much about how it is involved in mood regulation.

Serotonin plays several complex roles in the brain. It is involved in regulating mood, sleep, appetite, and sex drive. Low levels of serotonin are associated with aggression, irritability, and depression. Serotonin is also responsible for hallucinations and regulating other neurotransmitters.

Endorphins are the brain’s natural opiates. They influence the perception and control of physical and emotional pain. In addition to pain relief, they are responsible for feelings of well-being, happiness, and euphoria.

Drugs act on these messenger chemicals to increase, decrease, or alter their release or reuptake. Our brain is wired to recognize these chemicals and accept their messages. The difference is that drugs relay the message better, faster, and in a much more intense way. Research shows us that life experiences affect the development of the brain, including how neurotransmitters work. For example, someone who has experienced trauma may find it difficult to feel pleasure or regulate their mood due to low levels of dopamine and serotonin. This may cause them to turn to externally supplied chemicals to balance the levels of neurotransmitters in their brain.

The next, and final, installment of this series will explain why some people turn to recreational drugs in an attempt to balance the chemical messengers of the brain.

Photo credit: Life Mental Health

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This is your brain on drugs. For real.

This is the third installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.

This is not your brain on drugs. These are burnt eggs.

This is not your brain on drugs. These are burnt eggs.

Addiction is scary. It has caused pain in many people’s lives and has cost families and governments trillions of dollars to treat and prevent. It’s no surprise that social service agencies want to educate the general population about the harms of addiction. You may have seen this public service announcement comparing the addicted brain to fried eggs. The image is powerful, yes, but it is not educational. This is what actually happens in your brain when you take drugs.

Neurons generate messages that travel between cells in the brain.

Neurons generate messages that travel between cells in the brain.

Above is an image of a neuron. Our brain is filled with billions of these nerve cells and fibers. They contain genetic information and also serve as messengers. They transmit information through fibers from one cell to another via electrical charges. Neurons generate messenger chemicals, or neurotransmitters, to transmit information from cell to cell. The electrical charge travels through the dendrites, cell body (or soma), axon, and terminal bud down to the synapse, the gap between neurons where the magic happens. Neurotransmitters live in the terminal bud of neurons. An electrical charge comes through the neuron and releases the messenger chemicals. The chemicals then float across the synapse and attach to the neighboring cell for a short amount of time in a process called neurotransmission. Once the message has been relayed, they return to their home cell. This process is called reuptake. For example, if you were to burn your hand on the stove, nerve cells in your muscles would send a message to the neurons in your brain saying, “Ouch!” Your brain sends a message back down to the muscles in your arm to pull your hand back. At the same time, the message from your burning hand also alerts your brain to release endorphins, the brain’s natural pain reliever. The endorphins do their job and relieve the pain long enough so you can think to run cold water over your hand. Once the message has been communicated, the endorphins return to their home cell until the next electrical charge commands them to be released.

 

THIS is your brain on drugs.

THIS is your brain on drugs.

Above we have a close up of the synapse, the gap between neurons, and what happens when cocaine is present in the brain. The red arrows show the process of reuptake. The neurotransmitter dopamine has been released into the synapse to send a message to the neighboring cell. Once dopamine has completed its task, it attempts to go back home, but cocaine is blocking the way. Since dopamine can’t go back home it goes back to doing it’s job, binding to the neighboring cell. Dopamine’s loitering, so to speak, is what causes feelings of intense pleasure and euphoria.

Dopamine is only one of dozens of neurotransmitters in the brain. In the next installment, we identify the major neurotransmitters involved with drug use.

Photo credits: burnt eggs by incredibledictu, neuron, and neurotransmission by NIH. 

 

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The Neurocircuitry of Addiction

Drugs and compulsive behaviors have an impact on the reward center of the brain.

Drugs and compulsive behaviors have an impact on the reward center of the brain.

This is the second installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.

Addiction causes changes to brain structures that regulate pleasure, motivation, and decision making. Depending on the type of drug abused and the length of the abuse, these changes can be permanent. Other factors, such as pre-existing abnormalities in brain structure (like depression, schizophrenia, or ADHD) can also make the effects of drug misuse irreversible. The primary brain structures affected by drug use and compulsive behaviors are the ventral tegmental area (VTA), the nucleus accumbens, and the prefrontal cortex.

This is your brain

The VTA is the birthplace of dopamine, a chemical that signals the brain about pleasure. It is involved in cognition, motivation, intense feelings of love, addiction, and psychiatric disorders like schizophrenia and ADHD.

The nucleus accumbens (NA) is the reward and pleasure center of the brain. It sends the chemical messenger of pleasure, dopamine, to various areas of the brain, depending on the message. Permanent changes occur to this brain structure with repeated drug use. These changes explain drug tolerance (needing to take more drugs to feel high) and drug withdrawal (physical and psychological discomfort when drug use stops abruptly). The NA is also involved in fear, aggression, laughter, impulsivity, and learning.

The prefrontal cortex (PFC) is the part of the brain that separates us from other animals. It is involved in executive functioning, complex brain functions that  include differentiating from good and bad or same and different, future consequences, predicting expectations based on actions, working towards a goal, and suppressing urges that might be deemed socially unacceptable. In the brain of addicted individuals, the PFC is thought to be involved in anticipation of the drug, motivation to seek out the drug, craving, automatic responses to emotions, and reduced self-control.  Once a person becomes addicted, their attention narrows to focus on drug-related cues over all other reinforcers, impulsivity increases, and basic emotions become unregulated.

In the next installment, we’ll dive even deeper into the brain to look at the role drugs have in neurotransmission.

Photo credit: Lydia Kibiuk and BrainFacts.org

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The Neurobiology of Addiction

Brain_Broccoli_by_faiizeThis is the first installment of a five part series on the neurobiology of addiction by Jennifer Fernández, PhD. Follow along on Power Over Addiction or Facebook.

Addiction is a biopsychosocial phenomenon that affects over 20 million people in the United States. The factors that cause addiction are not yet well understood, with some arguing that it is a disease and others suggesting it’s more complicated than that.

But we can identify some predictors for addiction and we do understand the impact it has on the brain.

This five part series will primarily focus on current understanding about the brain structures and neurotransmitters involved in addiction. We’ll also look at the interaction specific drugs have with neurotransmitters in the brain and how this accounts for preferences in drug selection. We’ll start with an overview of addiction theories then dive into the neurocircuitry and neurobiology of addiction. We’ll conclude by looking at the effect of drugs on neurotransmitters in the brain and discuss why one develops a drug of choice.

Theories of addiction

Although we don’t fully understand addiction, there are lots of theories that attempt to explain it. The most popular one is the disease model. It explains that addiction has a biological origin that causes changes in the brain. This model also accounts for the heredity of addiction, or genetic predisposition. Studies of twins who have been separated at birth show that they are likely to develop addictions, despite growing up in different home environments.

You may have also heard addiction described as a hijacker of the reward center of the brain. Brain imaging studies show that overuse of drugs or compulsive behaviors “hijack” the reward system and can lead to changes in the brain that make it difficult to experience pleasure as one did before.

Then there’s the self-medication hypothesis. It posits that people use drugs to help them cope with physical and/or emotional pain. It helps explain why people turn to specific drugs or compulsive behaviors to help them deal with things like depression, chronic pain, trauma, or grief.

But the best way to explain addiction is as a biopsychosocial phenomenon. We know that addiction has a biological component. It causes temporary and permanent changes in the brain and body. We also know there is a psychological component: an inability to cope with distressing emotions. The social component of addiction is related to peer culture, as they influence what you use, how you use it, or how (not) to deal with your emotions.

In the question about nature versus nurture, the answer might just be nature and nurture. Drugs affect us biologically and we may even be genetically predisposed to those effects. Your parents, family, friends, or lovers may have modeled addictive behaviors or inability to cope with emotions in a healthy manner.

The next installment of this series will focus on the neurocircuitry of addiction.

Photo credit: Faiize

 

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Zap away cocaine addiction with lasers! or magnets!

brain laserResearchers at the National Institute of Health and UCSF claim to have stopped and started cocaine addiction in rats with the use of laser stimulation to the prefrontal cortex, the brain region where decision making and impulse control take place. “When we turn on a laser light in the prelimbic region of the prefrontal cortex, the compulsive cocaine seeking is gone,” said Antonello Bonci, MD, scientific director of the research program at the NIH’s National Institute on Drug Abuse (NIDA).

Studies with human subjects are already being designed ,according to Billy Chen, the lead researcher. But lasers wouldn’t be used with human participants. Prefrontal cortex stimulation would be achieved through the use of transcranial magnetic stimulation (TMS) which is currently being used as a treatment for depression. It should be noted that the jury is still out on the efficacy of TMS to treat depression, as reported in the journals Current Pharmaceutical Design and Pharmacology and Therapeutics.

This is all very interesting, but addiction is more than biological. People don’t become addicted to a drug because of their neuroanatomy and neurochemical environment. It’s more complex than that. It seems unclear to me what exactly changes in the prefrontal cortex due to this stimulation. Does it make a person (or a rat) more mature and logical in their decision making process? If that’s the case, there may be many uses for this technology! Needless to say, I’m skeptical.

You can read the abstract and view supplemental information about the study in Nature.

Thanks to Jim Wiggins for sharing this article.

Photo credit: Block and Tackle Productions

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Researchers stop stress-related relapse in rats

stressWe all deal with stress and have to learn methods to reduce and manage the stressors that life throws at us. But for someone with an addiction, day to day stressors can have a disastrous impact. Stress can trigger relapse, especially early in the recovery phase of addiction when new coping skills are being introduced and a person experiments with various strategies to find those best suited to their lifestyle needs.

Past research has focused on the psychological and emotional mechanisms involved in stress-induced relapse and there has been some speculation about the brain structures and neurotransmitters involved, but now researchers from Brown University and the University of Pennsylvania have found that by blocking kappa opioid receptors in the ventral tegmental area (VTA), rats under stress do not relapse on cocaine.

The VTA is the brain structure responsible for rewarding the fulfillment of basic needs, like hunger, sleep, and love. It contains dopamine releasing neurons that communicate with other brain structures, like the nucleus accumbens and the pre-frontal cortex when a basic need is met. It’s also involved in the rewarding release of dopamine when one uses a drug. GABA is an inhibitory neurotransmitter that slows down the release of dopamine in the VTA of a healthy brain.

Kappa opioid receptors are released in the VTA during stress and interrupt GABA’s process. By blocking those receptors in rats, researchers found they were able to resist relapsing on cocaine after five minutes of stressful exercise. “If we understand how kappa opioid receptor antagonists are interfering with the reinstatement of drug seeking we can target that process,” Kauer said. “We’re at the point of coming to understand the processes and possible therapeutic targets. Remarkably, this has worked.”

This is exciting news in the field of addiction as we are learning more and more about the neurobiological underpinnings of this devastating disorder. Researchers are especially excited about the potential to develop prescription drugs to help prevent relapse, and although this prospect may help people overcome their addiction, it is important to remember that addiction is more than just neurobiological processes. People overcoming addiction also need to learn emotional regulation and healthy alternatives to fulfill unmet needs in their lifestyles.

You can read more about this study here.

Photo credit: bottled_void

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