You Might Be An Addict

(And by ‘Might Be’ I mean ‘Are’)

The “Opioid Crisis” is all over the news these days, thanks to cheap heroin cut with fentanyl and heaven-knows-what-else that’s filling up morgue drawers throughout the country. If you think the numbers of overdose deaths are staggering now, medical examiners would be up to their elbows in bodies without Narcan, a drug that scrubs opioids off of the brain’s receptors during overdose, literally snatching people from the grip of the Grim Reaper. Many people that have stopped breathing and whose hearts have stopped beating are only on this side of the grass because of tthis wonder drug. While addiction has recently become a hot topic, it’s certainly not like it’s new, though we do seem to find plenty of novel substances to become addicted to all the time. Also not new is the stigma and overwhelming shame attached to addiction, attached to being an addict. It elicits such a strong negative response that we’re not even supposed to use the word ‘addiction’ anymore- it’s too derogatory- so now we’re to refer to it as ‘substance use disorder,’ lest we offend anyone. That said, to save myself some aggrevation, I am still going to use the word addiction in all of its various forms (shhh!) so I apologize in advance if anyone takes offense. I’ll also be using the term ‘using’ when referring to the use and abuse of drugs and alcohol.  I’m actually amazed that the word addiction is so stigmatizing that even physicians aren’t supposed to dare utter the term. That just goes to show that no matter how we raise awareness about addiction, about how it affects people in every walk of life, and that anyone can become an addict, nobody wants to be labeled as one….especially an addict in denial. It ain’t just a river in Egypt.

I’ve been listening to people’s deepest and darkest thoughts for over 30 years, and in that time I’ve heard people rationalize every behavior and habit under the sun, but none as vehemently as the abuse of alcohol and drugs. The way these rationalizations percolate through people’s minds is interesting. They’ll say, “I’m not an addict because I don’t use that much” or “I’m not an alcoholic; I only drink a little here and there.” To this I tell them that it’s not how much they do or don’t use that makes them an addict. That’s generally when they say, “Well, I know I’m not an addict because I don’t have withdrawls, I don’t get tremors and I don’t shake, even when I don’t use for weeks.” Hmmm. I think they think that one stumps me. But it doesn’t. “Nope, I hate to tell you, that’s not at issue either. Just because you don’t have withdrawals does not mean you don’t have an addiction.” To this they say, “But, but, I only use in certain situations, like at weddings, or funerals…” Blah, blah, blah, blah.  Doesn’t matter- where you use or how often- it just doesn’t matter in terms of whether you’re an addict or not. And then there’s the flotsam and jetsam of rationalizations: “I would never shoot up, I just wouldn’t do that; I never drink shots, I only drink beer; I don’t use marijuana wax, I only smoke a joint every now and again; I would never take pills, I only drink.” The list goes on. The truth is that the amount you use, when you use, how often you use, where you use, whether you withdraw or not, and the means by which you get the drug into your system does not factor into determining if you’re an addict; those things matter not. Right now you may be wondering, ‘So what does matter?’ How do you tell if someone’s an addict? There are behavioral, physical, and psychological factors that can be examined to make the determination. First, I’m going to cover the behavioral stuff, and then I’ll get to the physical and psychological stuff. There are essentially five general behavioral criteria to consider if You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The first criteria centers on relationships with the people around you. Does a significant other- a lover, partner, spouse, parent, sibling, grandparent, etc- complain about your using? Do they say you change when you use…that you’re a different person? Sound familiar? Do you blow off responsibilities to use? Does finding the money for the drug, getting the drug, and using the drug occupy your mind above all else? Does it change the priorities in your life? Do people in your life complain you’re irritable or that you’re no fun anymore? Do you withdraw and isolate yourself to use or while high? The complaints of family, friends and loved ones are signals that using is impacting significant relationships. This is a definite sign that addiction is present. I have patients say, “I get up and go to work every day, blah blah blah blah; I make money to support my family; I’m a good provider; I do this, I do that; I still go to the gym every day, yada yada yada…” Yeah, but you come home and drink three martinis and yell and scream at your children and your wife. Yeah, but you spend all day Saturday locked in your study in an Oxycontin haze. Those things are problematic! If using impacts significant relationships, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The second factor to consider is the use of drugs and/ or alcohol in spite of physical, emotional or personal damage; damage to mind and body. Some examples: the alcoholic who is gaining weight and having liver failure. The woman who smokes tobacco but needs oxygen to breathe. The man who smokes marijuana who can’t think clearly, has memory deficits and thought and decision-making issues. The woman who’s smoking meth even though it’s killing her lungs and rotting out her teeth with meth mouth. The guy who’s injecting heroin even though he’s got gnarly scabs and infected abcesses all over his arms and legs. The man who has a cocaine problem but continues to use in spite of arrhythmias and strokes. If using causes physical and/ or mental issues but you still use regardless, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The third factor focuses on work, your employment. Problems at work, starting to miss work, starting to come in late, making mistakes at work, poor relationships with co-workers, lacking follow-through, becoming lackadaisical or flippant at work, and not excelling/ achieving at work, especially if the behavior is new or recent. These are all drug-related signs. People say, “Oh, for 23 years I’ve gotten up and gone to work every single day and I’ve done fine.” Sure. Okay, but in that 23 years, how many times have you been promoted? Have your reviews and evaluations shown consistent improvement? Or does your boss complain about your personality, how you don’t have a good attitude, how you’re forgetful of things, how you seem to have no energy, how it seems like you’re not enjoying your work? If using affects your work performance in any way, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).  

Factor number four is pretty simple: legal issues and their consequences. DUIs come to mind, but any legal problems stemming from the use or abuse of drugs and alcohol count here. That might include anything from charges for possession of drugs, fighting in public, assault, disorderly conduct, disturbing the peace or domestic violence all the way to charges associated with vehicular collisions, even manslaughter. If using has put your attorney’s kids through private school, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’). 

The fifth and final criteria is a two-fer; it’s super important because the first part is the one thing you can never get back once it’s gone, and the second part is something very hard to get back once it’s gone. Any guesses? Give up? They are time and money. Time spent using is wasted; (no pun intended) it’s time gone from your day, your week, your month, your year, and ultimately gone from your life for good. That time could’ve been better spent being productive, doing literally anything but using. As for money, Captain Obvious says that money spent on drugs or alcohol is also wasted; it too could’ve been better spent on literally anything but drugs or alcohol. The amount of time and money spent using may prevent you from making more money, because the time you might have spent on a money-making opportunity is spent on using. What’s more, time and money act as a barometer for the severity of addiction…when one goes up, so does the other, and the more of both spent, the more severe the addiction. If you waste your time and money buying and using drugs and alcohol, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

So just to review, what are the five behavioral criteria to help determine if You Might Be an Addict? If friends and family complain; if there are physical and psychological issues from using drugs and alcohol but use continues regardless; if there are job-related problems from using drugs and alcohol; and if there is time and money misspent and opportunities lost to using…You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

Family members, friends, and co-workers are usually in the best position to recognize a drug problem as they are familiar with the person’s habits and behavior, but considering the weight of the word addiction, you can’t just point an accusatory finger at someone. You must educate yourself on the signs of drug abuse. Above we discussed five behavioral factors that can signal drug addiction, but there are also physical and psychological signs to be aware of as well. Recognizing the signs of addiction is the first step to ending addiction, so I want to give some practical information on the physical signs of addiction, overdose, and withdrawl. These signs are the body’s physical manifestations resulting from the presence of drugs or alcohol in the body. 

General physical signs of addiction include, but are not limited to:

– Enlarged or small pupils (opiate use often causes pinpoint pupils)
– Sudden weight loss or gain
– Bloodshot eyes
– Insomnia
– Unusual body odors
– Poor physical coordination
– Looking unkempt
– Slurred speech

Overdose is a medical emergency. In case of overdose, please seek immediate emergency care. Typical signs of an overdose may include, but are not limited to:

– Drowsiness or trouble walking
– Agitation
– Aggression or violent behavior
– Difficult/ labored/ ceased breathing
– Nausea and vomiting
– Hallucinations
– Delusions
– Loss of consciousness

Withdrawl can be a medical emergency. Please consult a physician during withdrawl events. Typical signs of withdrawl may include, but are not limited to:

– Shakiness, trembling, jumpiness
– Loss of appetite
– Nausea and vomiting
– Depression
– Insomnia and fatigue
– Headaches and fever
– Confusion and hallucinations
– Seizures (lasting over 5 minutes is immediate emergency)

In addition to behavioral and physical signs of addiction, drug abuse also impacts a person’s psychological state. When they’re in the grip of active addiction, the person might not realize or recognize these changes. The psychological signs of drug addiction may include, but are not limited to:

– Anxiousness
– Inattentiveness
– Lack of motivation
– Irritability or angry outbursts
– Changes in personality or attitude
– Emotional/ mental withdrawl
– Sudden mood swings
– Unexplained paranoia

We’ve covered the behavioral, physical, and psychological criteria that indicate You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’). Or should I say You Might Have Substance Use Disorder (And by ‘Might Have’ I mean ‘Have’). I like the first better. No matter what you call it, you don’t have to live life in addiction. Actually, that’s an oxymoron- there is no living life in addiction. And if you do oxy, are you a moron? An existential question to ponder. 

For more information and stories about addiction, check out my book, Tales from the Couch, available on Amazon.com.

The Dangers Of Alcohol

As an addiction specialist, I see patients abusing substances of all kinds. Today I’d like to talk about alcohol. It is so ingrained and accepted in our society. Pop culture would have you believe that you can’t have any fun or lead a fulfilling life without alcohol. During nearly every commercial break on television, there is an advertisement for alcohol, full of smiling people having the time of their lives like they’re on a permanent vacation. As a matter of fact, as I write this, I have a television on in the background, and there was just a commercial for a Mexican beer. It was a fiesta, with women in bright costumes dancing around and people cheering and cheersing with cold cervezas. The message: you’re clearly missing out if your life doesn’t resemble the lives of these people, but if you drink their beer, your life can be as awesome as theirs.  

Fermented grain, fruit juice and honey have been used to make alcohol for thousands of years. Even early Greek writings warned of the perils of alcohol. In our modern world, the dangers of alcohol are well studied and well known. Despite this fact, alcohol is the most common drug used and abused by people. Here are some sobering facts and figures: an estimated 15 million Americans suffer from alcoholism, and nearly 90,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 40% of all car accident deaths in the United States involve alcohol, claiming approximately 10,000 lives a year. According to the Institute of Alcohol Studies, consuming larger amounts of alcohol can cause more than 60 different health issues and hundreds of physical conditions.

Day in and day out, I witness the ravages of alcoholism, and it’s not pretty. Alcohol in any amount affects every part of a person, inside and out. It’s just a matter of degrees. 

What are these effects? Let’s start with the outward appearance. While drinking moderately may not have immediate disadvantages, over time you’ll start to notice them- especially when you look in the mirror. Drinking alcohol dehydrates you, which makes hair follicles dry and brittle and more likely to cause hair to fall out. What hair you have will look crispy with split ends. Heavy alcohol use can lead to permanent damage to the health of your hair. It can also cause hormonal issues like increased estrogen, which can cause problems with hair growth and loss, particularly in men.   

Drinking too much also dehydrates and deprives the skin of vital vitamins and nutrients. Instead of being soft and hydrated, your skin will begin to look cracked and wrinkled. This will leave others thinking you may be older than you actually are. Excess alcohol also alters blood flow to the skin, leaving an unhealthy appearance for days.Alcohol can also cause your face to look pale, bloated and puffy.Sometimes the blood vessels on your face burst and the capillaries break, causing a chapped look. Not only can your face become red, but the tiny blood vessels in your eyes become irritated and rupture, causing bloodshot eyes. Not cute. 

Over time, drinking heavily can have other, more permanent, detrimental effects on your skin. Rosacea, a skin disorder that starts with a tendency to blush and flush easily is linked to alcohol consumption. Continued alcohol consumption can eventually lead to a condition called rhinophyma, a facial disfigurment that is a subtype of rosacea, where large, red, pus-filled bumps develop on the face, commonly on the cheeks, chin, and especially the nose, where it can cause severe bulbous distortion. If you have rosacea, I strongly urge that you google rhinophyma and that you don’t drink. 

Let’s not forget that alcohol is fattening, high in empty calories. A couple of gin and tonics and a pint of beer equal about the same calories as a big fast food burger. You might be surprised to find out what the junk food calorie equivalents are for your favorite drinks. Alcohol also bloats your stomach. “Beer belly” is real people, but not only caused by beer. And then there’s cellulite; many believe the toxins in alcohol contribute to its build up. 

A less often discussed result of drinking heavily is B.O. Yes, the bad odor emanating from the body after a long night of drinking is directly related to the alcohol seeping from it. According to the Institute of Alcohol Studies, over 10 percent of alcohol consumed leaves the body unused through your sweat, breath, and urine. While pretty much everyone can smell it, non-drinkers are generally especially susceptible to the odor. And it is gross. Keep that in mind the next time you wake up after a bender. Your body odor could leave a lasting impression.

Let’s move from external effects of alcohol and go inside the body, starting with the brain. Obviously, when you’re drunk, your brain is impaired. There is loss of inhibitions, confused or abnormal thinking, and poor decision-making. But I want you to understand the chronic effects of alcohol on the brain and cognition, the long term effects. So, how does alcohol impact cognitive ability? Clearly, the impact is directly related to the frequency and quantity of alcohol consumed. 

Occasional and moderate drinkers:
– Memory impairment
– Blackout
– Recklessness
– Impaired decision-making

Heavy and/or chronic drinkers:
– Diminished gray matter in the brain
– Inability to think abstractly
– Loss of visuospatial abilities

-Memory loss

-Loss of attention span

In general, heavy alcohol use causes the brain to shrink. Any alcohol use causes clouded thinking, slow thought process or delays in cognition. If you drink at night – even two drinks – the next day, your thoughts aren’t as fluid, you’re not as clear, you’re not as creative. Alcohol use changes behavior. You may develop psychological issues,  personality issues. It is well established in the mental health field that alcohol consumption can exacerbate underlying mental health disorders. People become more irritable, anxious, and depressed when they drink. So why do it? People use it as a coping skill. It lowers inhibitions, gives “liquid courage” and allows us to do things we wouldn’t normally do. Some people use it to keep a job they hate, or to stay in a miserable marriage. It numbs pain, it’s an escape hatch for the psyche. It becomes a solution to a problem, or a way to mask the problem. Just as we are all different, the way alcohol affects us all differently. 

The following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
-The volume a person drinks
-How often a person drinks
-The age at which drinking began
-The number of years a person has been drinking
-The person’s sex, age, and genetic factors
-Whether the person’s family has a history of alcoholism
-Whether the person was exposed to alcohol as a fetus
-The person’s general health 

One of the biggest problems with alcohol that I see is trauma, people getting hurt. When you drink alcohol, your decision making is impaired. The brain that usually protects you is suddenly impaired, so you fall, you fight, you drive a car recklessly, and your coordination is off. You’re going to fall or make a bad decision and get hurt. So many accidents and deaths are attributed to alcohol. It’s especially disturbing because they’re preventable.

There is no bodily system that alcohol does not affect. What are other physical dangers of alcohol? Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast. The common thing that everyone understands is liver damage with alcohol. It causes fatty liver and cirrhosis of the liver which eventually kills you. There are a host of digestive problems with alcohol consumption: peptic ulcers, bleeding ulcers, diarrhea, pancreatic cysts/disease/failure. Alcohol can lead to diabetes, a compromised immune system, lung infections, stroke, and heart disease. It can be associated with memory issues, learning disorders, and neurological problems, where you have numbness in your arms and legs, lack of coordination, and slurred speech.   

Alcohol plays a role in other issues as well. Family problems, legal problems, and social problems. One of the biggest concerns with drinking frequently is (or should be) dependency, becoming an alcoholic. Right now, I’m sure almost 100% of you are thinking ‘I‘d never become an alcoholic.’ There’s a television show called Intervention that documents the trials, tribulations, lifestyles, and consequences of alcoholics and drug addicts. None of them planned on becoming alcoholics back when they drank socially or just had a few drinks at night. The great news is that if you never make alcohol a part of your life, guess what? You’ll NEVER have to be an alcoholic or deal with all of the issues that come with it. I can’t stress enough how strongly you should take this to heart. 

By now I’m certain that you understand the ravages and damages of alcohol use and abuse. But the dangers are minimized and we’re desensitized to it by pop culture; it’s so ubiquitous that we accept it as a part of life. If you tell someone that you don’t drink, they look at you like you have three heads. It is ingrained in every aspect of our society in terms of weddings, funerals, bars, restaurants, hotels, public events, private events, and clubs.  

Have you ever noticed how glorified alcohol is? They put it in these beautiful bottles. I admire alcohol bottles. The artistry and sculpture of the bottles…they’re just beautiful. They look like there must be something very good inside, so you want to find out. When you go to a restaurant, the first question is always, “Would you like a drink?”  Now, children’s birthday parties even serve drinks to the adults. If it’s so safe, why don’t we serve it to children? It’s because we know it’s poison, we know it’s dangerous, but it’s minimized. It’s socially acceptable. I’m not for prohibition; I think there is a place for alcohol in our society, but it shouldn’t be so glorified and so easily accessible. We need to acknowledge it’s dangers and be more restrictive with it. Take all-you-can drink mimosa or bloody mary brunches or happy hours for example, where drinks are two-for-one. These things encourage drunkenness, and then people leave with alcohol-induced poor decision skills and car keys in hand. These sorts of events need to be seriously restricted. There should be no event where we encourage people to get drunk. We should not condone its overuse or extoll its virtues. 

With all of that said, how does an individual stop drinking alcohol? It’s a simple theory. You make a decision to stop, and then you stop. There is no other way. If you’re not in control of stopping, then who is? I’ve spent more than thirty years medically detoxing and working with people with alcohol and drug addictions, and I assure you that there is no other way to stop other than the person making the decision to stop and living with it. I’m not saying it is easy, especially with alcohol all around us in grocery stores, restaurants, on television, on billboards…it is everywhere. But it can be done. I see it every day, people living fulfilling lives without alcohol. If you want to be one of those people living without alcohol, make an appointment. I can help you. I talk more about this in my books, A Chance to Change and Tales from the Couch, both available on Amazon.

The Agresti Addiction Scale

The Agresti Addiction Quiz is designed to provide you an idea of whether a drug addiction or drug abuse problem exists. The drug addiction quiz is not perfect and the drug addiction quiz should only be seen as a guide.

Alcoholism: Is Alcohol Negatively Affecting Someone You Love?

How do you know when alcohol is negatively affecting someone you love? What should you do when you suspect that someone you know is suffering from an alcohol addiction? This article will help you discover signs and symptoms so that you can be prepared to take the proper action against alcohol abuse and addiction.

First, let’s consider the facts. Someone you know or love drinks heavy amounts of alcohol on a regular basis. They seem fine, and their alcohol consumption doesn’t seem to disrupt their daily life. So how do you know if they are abusing alcohol or if an alcohol addiction is forming? Take a little extra time to notice how alcohol currently integrates with your friend’s or family member’s life. Do they drink alcohol every day, or several times a day? Is alcohol a “necessity” for them at every function or celebration? Does alcohol change their behavior significantly? And finally, do they turn to alcohol to deal with difficult situations such as job loss or grief? If you can answer yes to any one of these questions, your friend or family member may be beginning to abuse alcohol or on the verge of an alcohol addiction. If you can answer yes to more than one of these questions, then it may be time to step in and take some action to ensure the safely and health of your loved one. (more…)