Overcoming Addiction
By
Charles Atkins, MD
"Wouldn't it be great if you
could love me first and let the bottle wait?"
--Dolly Parton
"They tried to make me go to
rehab, I said, ‘No no no.’"
--Amy Winehouse
You know it’s killing you.
The alcohol, cigarettes, pain pills, illegal drugs whatever the habit is
that you’ve tried to change—repeatedly—but without success. Your conversations with yourself are familiar
as a favorite tee shirt, “I’ve got to stop…I’ll do it tomorrow.” And then tomorrow comes, and with it the urge
to drink/smoke/use illicit drugs and despite your best intentions you give in. “Okay, tomorrow then. I’ll really stop tomorrow.” So what’s wrong with us that we persist in
behaviors that harm us? And most
importantly, how does someone finally make the needed change?
As a psychiatrist who works with
people with drug and alcohol dependence I spend a lot of time on these questions. While the answers can be complex, I’m drawn
to some basic truths. First, the
destructive habit--whatever it is--serves a purpose, at least initially. The "why" someone begins to drink
or use drugs varies from person to person.
Alcohol provides a sense of relaxation and well being. For people who are anxious or socially
awkward it helps lubricate their tongues and makes them feel at ease in social
situations. Opiates (pain pills to
heroin) induce a state of euphoria and relieve not only physical pain, but
emotional suffering, as well. It’s no
coincidence that so many survivors of abuse and trauma become addicted to heroin
and prescription opiates.
For teens experimentation with drugs
and alcohol has become a passage rite. The
not-fully wired adolescent brain doesn't register the danger in the behavior,
and it’s during these young years where most pick up habits that turn ugly in
time. The magnitude of this is followed
by annual surveys that monitor high-risk behavior in teens. In 2009 24% of high-school students engaged
in binge drinking, nearly ten percent had driven in the past month when they'd had
alcohol, roughly 30% had been passengers in a car where the driver had been
drinking, 20% smoked cigarettes, 20% had used prescription drugs without a
doctor's order, over six percent had tried cocaine and/or Ecstasy, and 2.5% had
tried heroin.
Once established, negative behaviors
take on a rhythm and turn into a habit.
A smoker hears the phone and lights up, the morning cup of coffee is
accompanied by a smoke, and every work break includes a quick cigarette or two. A drinker anticipates the weekend, or the end
of the workday as the time for the first beer or cocktail. Passing a liquor store they think about
whether or not there's enough booze in the house, or who they’ll meet up with
for drinks at a favorite watering hole.
Depending on the drug of choice,
problems start to develop and can damage any and all aspects of a person's
life--physical and/or mental health, relationships, job, finance. An arrest for Driving under the Influence
(DUI) starts a cascade of losses and legal problems. Physical effects of excessive drinking
emerge, and dependence--the body's need for the continued presence of a
substance--takes hold. An opiate addict
no longer gets the euphoric high, but instead is chased by the physical and
emotional agony of withdrawal “Jonesing" that turns her life into an
unending search for the next fix. The
alcoholic becomes shaky in the morning, starts to drink throughout the day, has
unbearable anxiety, poor sleep, and somewhere around the 20-year mark of heavy
drinking heads into serious alcohol-related diseases such as cirrhosis and certain
cancers. A dangerous and potentially
fatal withdrawal syndrome--delirium tremens (The DTs)—traps the drinker and
their ability to “just go cold turkey” is no longer a safe option. As for cigarettes, there’s little doubt that
they represent the number one cause of preventable death in this country from
heart disease, cancer and stroke.
What's remarkable is that even in the
face of terrible losses--job, health, family--the destructive behavior persists. Deceit and minimization of the problem is
common, and attempts to quit or cut back are frequent and short lived. Motivation to do something about the behavior
is mercurial, changing from moment to moment.
Yet people can and do change. And just as the reasons why someone starts a
destructive habit are varied, the paths that lead someone to put down a bad
habit are particular to them. At some
point there is an awakening and with it a call to action. "This is killing me and I've got to
stop." For others it may be an
external force, a spouse threatening to leave, a child who can no longer bear
to see you drunk and cuts you out of their life, an illness or serious legal
problem that's a direct result of the addiction. Regardless, something in the equation shifts
and motivation moves into action: throwing away the cigarettes, dumping the
booze down the drain, checking into a detoxification program, attending a
12-step meeting. Again, there are many
paths and depending on the behavior, the severity of the addiction and the
person these vary from “going cold turkey” on your own to intensive treatment. Some will require the services of medical
professionals to get them through potentially dangerous withdrawals (alcohol
and certain Valium-family drugs), and many will turn to rehabilitation
programs, drug counselors and well-established self-help groups such as AA and
NA. The first days are the hardest as
well-worn patterns of behavior, and cravings have to be resisted and
changed. This is where familiar slogans
from 12-step groups such as AA become life savers, “One day at a time”. “Today I’m not going to drink or drug, I’ll
deal with tomorrow when it comes.”
What is clear for everyone who has successfully
put aside a destructive habit is that they’ve transformed a desire to change
into action. In time, the old
destructive behavior is replaced with newer and healthier ones. As I often tell my patients, putting down a
bad habit is both easy and hard. The hard
part is “just don’t drink” and the easy part is, “just don’t drink”.
