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What may have saved my acquaintance was that he was educated, had had a life long interest in philosophy. What may have also helped him refuse cocaine craving was that he had done psychoanalysis and through that process had learned to observe his own thoughts and emotions. He had begun analysis due to depression and perhaps the long process of contact with an empathic analyst and an ultimately successful marriage gave this man enough social contact and self repair that he could put the cocaine high into a much larger perspective and refuse the craving for a second snort of it.
This man had social contact. He had friends, he had developed a trusting alliance with his psychoanalyst, had a wife he respected, three children, and he knew he was responsible for a business and the welfare of many employees. So perhaps all of that put his feeling high and his craving into a much larger perspective.
Thank you for these fascinating excerpts and stories, corboy. Truly appreciated. I took a class from the psychotherapist who had coined the term "codependency" from her observations working with alcoholic men and their families, and she insists that as little as two weeks of what she terms "catastrophic stress" are enough to establish this self-destructive behavior pattern ("codependency"). And, of course, what amounts to "catastrophic stress" will vary from person to person and be a matter of that person's own individual emotional/intellectual makeup.
Dr. Gabor Maté, in his book on addiction, "In the Realm of Hungry Ghosts," points out that there is nothing about drugs that makes them addictive in and of themselves:
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Heroin is considered to be a highly addictive drug—and it is, but only for a small minority of people, as the following example illustrates. It's well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users. Along with heroin, most of these soldier addicts also used barbiturates or amphetamines or both. According to a study published in the Archives of General Psychiatry in 1975, 20 per cent of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1 per cent had been opiate addicts.
The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.” Heroin is considered to be a highly addictive drug—and it is, but only for a small minority of people, as the following example illustrates. It’s well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users. Along with heroin, most of these soldier addicts also used barbiturates or amphetamines or both. According to a study published in the Archives of General Psychiatry in 1975, 20 per cent of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1 per cent had been opiate addicts. The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.”
The remission rate was 95 per cent, “unheard of among narcotics addicts treated in the U.S.”“The high rates of narcotic use and addiction there were truly unlike anything prior in the American experience,” the researchers concluded. “
Equally dramatic was the surprisingly high remission rate after return to the United States.”
These results suggested that
the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts. [
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That's a significant shift in the thinking on illicit drugs, isn't it? Dr. Maté goes farther:
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To accept nothing less than complete abstinence is both unrealistic and irrational. There are many great people who achieved great advances who were addicted. Until we can remove the stigma of addiction and accept that some people, through no fault of their own, will need continuing doses of medication - yes,
medication - to function optimally, we will continue to simply perpetuate and increase suffering, dysfunction, and destruction.
The Vietnam veterans study pointed to a similar conclusion:
under certain conditions of stress many people can be made susceptible to addiction, but if circumstances change for the better, the addictive drive will abate. About half of all the american soldiers in Vietnam who began to use heroin developed addiction to the drug. Once the stress of military service in a brutal and dangerous war ended, so, in the vast majority of cases, did the addiction. The ones who persisted in heroin addiction back home were, for the most part, those with histories of unstable childhoods and previous drug use problems.
In earlier military conflicts relatively few US military personnel succumbed to addiction. What distinguished the Vietnam experience from these wars? The ready availability of pure heroin and of other drugs is only part of the answer. This war, unlike previous ones, quickly lost meaning for those ordered to fight and die in the faraway jungles and fields of Southeast Asia. There was too wide a gap between what they'd been told and the reality they witnessed and experienced. Lack of meaning, not simply the dangers and privations of war, was the major source of the stress that triggered their flight to oblivion.
Drugs, in short, do not make anyone into an addict, any more than food makes a person into a compulsive eater. There has to be a preexisting vulnerability. There also has to be significant stress, as on these Vietnam soldiers -- but, like drugs, external stressors by themselves, no matter how severe, are not enough. Although many Americans became addicted to heroin while in Vietnam, most did not.
Thus, we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress. Given the availability of drugs, individual susceptibility will determine who becomes and addict and who will not -- for example, which two from among a random sample of ten US GIs in Vietnam will fall prey to addiction. [
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To say that the drugs, in and of themselves, are addictive and can seize *anyone* who tries them has the pernicious undercurrent of resulting in blaming addicts for being stupid enough to *try* those drugs in the first place. It further stigmatizes these most vulnerable and abused of our citizens. I tried cocaine a couple of times when I was in college the first time; it did *nothing* for me. I was happier snorting speed :}
But by the time I was 22, I was completely *done* with recreational drug use. Who needs it? Addicts do not respond that way; they cannot say "Who needs it?". THEY need it. However, there are other substances that can substitute for the illicit drugs - like Ritalin for cocaine addicts. It provides the same positive effects they gain from their use of cocaine, without the danger, cost, and social censure of the illicit substance. How sad is it to think that so many people are addicted (and end up homeless) simply because they can't get decent medical diagnosis and treatment??
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For 12 years I was staff physician at the Portland Hotel, a nonprofit, harm-reduction facility in the Downtown Eastside, an area with an addict population of 3,000 to 5,000. Most of the Portland’s clients are addicted to cocaine, crystal meth, alcohol, opiates like heroin, or tranquilizers—or to any combination of these things.
“The first time I did heroin,” one of my patients, a 27-year-old sex-trade worker, once told me, “it felt like a warm, soft hug.” In a phrase, she summed up the deep psychological and chemical cravings that make some people vulnerable to substance dependence.
Contrary to popular myth, no drug is inherently addictive. Only a small percentage of people who try alcohol or cocaine or even crystal meth go on to addictive use. What makes those people vulnerable? According to current brain research and developmental psychology, chemical and emotional vulnerability are the products not of genetic programming but of life experience. Most of the human brain’s growth occurs after birth, and so physical and emotional interactions determine much of our neurological development—which brain areas will develop and how well, which patterns will be encoded, and so on. As such, each brain’s circuitry and chemistry reflect individual life experiences as much as inherited tendencies.
Drugs affect the brain by binding to receptors on nerve cells. Opiates work on our built-in receptors for endorphins—the body’s own, natural opiate-like substances that participate in many functions, including regulation of pain and mood. Similarly, tranquilizers of the benzodiazepine class, such as Valium, exert their effect at the brain’s natural benzodiazepine receptors. Other brain chemicals, including dopamine and serotonin, affect such diverse functions as mood, incentive- and reward-seeking behavior, and self-regulation. These, too, bind to specific, specialized receptors on neurons.
But the number of receptors and level of brain chemicals are not set at birth. Infant rats who get less grooming from their mothers end up with fewer natural “benzo” receptors in the part of the brain that controls anxiety. Brains of infant monkeys separated from their mothers for only a few days are measurably deficient in dopamine.
It is the same with human beings. Endorphins are released in the infant’s brain when there are warm, non-stressed, calm interactions with the parenting figures. Endorphins, in turn, promote the growth of receptors and nerve cells, and the discharge of other important brain chemicals. The fewer endorphin-enhancing experiences in infancy and early childhood, the greater the need for external sources. Hence, a greater vulnerability to addictions.
What sets skid row addicts apart is the extreme degree of stress they had to endure early in life. Almost all women now inhabiting “Canada’s addiction capital”—as the Downtown Eastside of Vancouver has been called—suffered sexual assaults in childhood, as did many of the males. Childhood memories of serial abandonment or severe physical and psychological abuse are common. My patients’ histories are chronicles of pain upon pain.
The U.S.-based Adverse Childhood Experiences studies have demonstrated beyond doubt that childhood stresses, including factors such as abuse, addiction in the family, a rancorous divorce, and so on, provide the template for addictions later in life. It doesn’t follow, of course, that all addicts were abused or that all abused children become addicts, but the correlations are inescapable.
If we look closely, we’ll see that addictive patterns characterize the behaviors of many members of society, including high-functioning and respectable citizens. As a workaholic doctor, I’ve had my own non-substance addictions to feverish professional activity and also to shopping. In my case, I can trace that back to emotional losses I suffered as a ¬Jewish infant in Nazi-occupied Hungary during the last years of World War II. My children, in turn, were subjected to the stresses of a family headed by a workaholic father who was physically present but emotionally absent.
Feeling alone, the sense that there has never been anyone with whom to share their deepest emotions, is universal among drug addicts. No matter how much love a parent has, the child does not experience being wanted unless he or she is made absolutely safe to express exactly how unhappy, or angry, or hate-filled he or she may at times feel.The sense of unconditional love, of being fully accepted even when most ornery, is what no addict ever experienced in childhood—not because the parents did not have it to give, but simply because they were too stressed, or overworked, or beset by their own demons, or simply did not know how to transmit it to the child.
Addicts rarely make the connection between troubled childhood experiences and self-harming habits. They blame themselves—and that is the greatest wound of all, being cut off from their natural self-compassion. “I was hit a lot,” 40-year-old Wayne told me, “but I asked for it. Then I made some stupid decisions.” And would he hit a child, no matter how much that child “asked for it,” or blame that child for “stupid decisions”? “I don’t want to talk about that crap,” said this tough man, who has worked on oil rigs and construction sites and served 15 years in jail for robbery. He looked away and wiped a tear from his eyes.
Some of the above is from a Yes Magazine article on Dr. Gabor Maté and his work: [
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The article is titled "Why Punish Pain?"
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Were you just on the point of quitting when the smiles and affirmations were turned back on?
Funny you should ask. At the last discussion meeting I ever attended, we were sitting around afterward - it was in January of 2008, so we were all focusing on the year to come. I was suggesting that we ask the members what sorts of topics they would like to discuss and what sorts of activities they would enjoy - a book-club-type of activity, or maybe watching a movie together, or something. No one said "That would be out of rhythm - we have to use the topics that are dictated from on high", even though in looking back, I can see that was the process. And then, when I mentioned to my MD District leader that I wasn't getting any of my needs met in the discussion meetings, he told me, "You are being really selfish. Instead of thinking about yourself, you should be thinking about how to use all your training and knowledge to help others." I was the only one who really studied, you see. How's THAT for "smiles and affirmations"???