(Translation into most languages at tab to the right)
I want to continue with the thoughts from my November blog on The Cycle of Harm and how we now know that the War on Drugs has failed miserably. And especially in attempting to dissuade teens and young adults from using drugs, a punitive approach to drug use has failed spectacularly. There are many reasons for this: the development of the teen brain, the growing need for autonomy, and the influence of culture and their friends, among other things.
There have been innumerable research studies on the teen brain. “The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so. In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part.” (1)
While the teen years are when our brains can comprehend and store new information at its highest rates, the ability to process that information in light of future consequences just isn’t there yet. And during these years there is a need to separate from our parents and begin the process of becoming an adult.
David Robson, in an article for the BBC, says, “Adolescents often desperately crave the approval and acceptance of their parents. So while they certainly do want independence, it is not at any cost. Brain imaging studies show that the regions of the brain associated with reward generally develop more quickly than those associated with inhibition and self-control. They have greater activity in their dopamine signaling – a neurotransmitter associated with pleasure and curiosity – compared to both adults and younger children, with bigger spikes when they experience something that is novel or exciting. In this light, it’s little wonder that teens are more likely to be tempted to try new experiences…with impulsive and risky decision making.” (2)
Have you ever pondered how different people drive and approach the objective of getting from one place to another? Are there certain people you would rather not get into a car with when they are driving? I was thinking about this the other day when John and I were driving to meet friends and the same scenario played out when he is driving: the race is on. It’s not that John exceeds the speed limit too much – he’s only ever had a few tickets in his entire life – although he drives on the high end of the limit. But it is the way he views the entire undertaking.
This is nothing new. Years ago, we had rented a car to drive across Italy with our kids. We were on unfamiliar freeways where the speed limit was more of a suggestion than a limitation. Not much time passed before I, as the navigator in the front seat, was looking for anything I could hold on to in fear of my life as John joined in the race. After my repeated shrieks of “Slow down!” and exclamations of “Watch out!”, we decided that I needed to be in the back seat and close my eyes while someone with steadier nerves took my place.
His adrenaline was flowing and so was mine. But the difference was that for John, this was exciting. For me, it was terrifying. I am a risk-averse person and tend to avoid risks in most areas of my life as much as possible. Yet, I am also an anxious person and my adrenaline can flow when there is no real threat. But the ways it affects my life are different. One thing we all have in common is that these predispositions have a physiologic base and are most likely passed down to us from preceding generations.
What is adrenaline and what role does it play in our bodies and lives?
Adrenaline (epinephrine) is a hormone our adrenal glands make to help us prepare for stressful, threatening, or dangerous situations. Adrenaline rush is the name for the quick release of adrenaline into our bloodstream and turns on our sympathetic nervous system which gets our body ready for a “fight or flight” response to a real or perceived danger.
An Adrenaline Junkie is someone who seeks activities that give them that “rush” which is addictive. Recent studies have shown that dopamine and serotonin, neurotransmitters that regulate risk-taking and impulsivity, are downregulated in people with substance use disorders. (1) This means that if we constantly stimulate our adrenal glands, dopamine and serotonin are no longer able to help protect us from high-risk and impulsive decisions. We are then in need of, craving, more adrenaline, a vicious cycle.
But when I looked at the characteristics of an adrenaline junkie and thought about the things my husband seeks out and enjoys, he didn’t quite fit the pattern of seeking one-off thrills like skydiving, bungee jumping, hang gliding. He instead seems to regularly engage in high-risk activities and behaviors. How is this different than being an adrenaline junkie?
What I discovered in my search to understand is another type of adrenaline-seeking personality, High Sensation Seekers. When I looked at those characteristics, they fit him much more closely. I will go into them in Part Two of the next blog.
For others like me with minds that race full of thoughts and worry, adrenaline and other stress-related hormones like cortisol are released. The anxiety can be most pronounced when we are lying in bed and keep focusing on what has happened or what might happen in the future. That extra boost of energy has no use and instead leaves us restless and unable to sleep. The parasympathetic nervous system relaxes us and predominates in quiet and rest and drives our “rest and digest” systems. It conserves our energy for when it is needed. So, any type of adrenaline-using behavior depletes our adrenal glands and overrides our parasympathetic system leaving us exhausted.
In relation to addictions, we can easily see how risk-taking and thrill-seeking behaviors include heavy or binge drinking, using drugs, high-risk sex, gambling etc. Adrenaline addiction of any type brings with it withdrawal symptoms like cravings, decreased interest in other activities, and negative emotions and restlessness.
Regardless of how we deplete our adrenaline reservoir, here are some suggestions to help us respond to unhealthy urges or stress in our lives and to help restore our sense of well-being and peace:
prayer and meditation
deep breathing and muscle relaxation
regular exercise – which releases endorphins (3)
balanced diet– low in refined sugars and carbs, high in protein
avoid cellphones, bright lights, computers, loud music, and TV right before bedtime
leisure activities
listening to peaceful or positive music
creativity
social support
practicing gratitude
counseling/therapy
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(Thirty-fourth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
This week’s Story of Hope is from a young friend of ours, Anne (not her real name). Here are some excerpts from her story in Opiate Nation (5 min read):
I was eleven years old when I first experienced shooting heroin. Looking back, I can hardly believe it and I am so thankful to be alive, and to be sharing my story.
My boyfriend and I watched the movies Trainspotting and Requiem for a Dream and they really piqued our interest in drugs. The way it was portrayed in those movies made me think using heroin would be an amazing dream sequence, when in actuality, it made me violently ill. My boyfriend insisted we keep trying. He became obsessed with all drugs: ecstasy, LSD, cocaine, and various pills and so I tried them all.
(Thirty-first in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
There is something about the rise of a full moon that I just love. I’m not sure why it holds such fascination for me, but it always has. I’m greedy about it – I wish we had a full moon every night, like we have the sun every day. When I was growing up in Tucson, Arizona, I loved anticipating the moon’s first peek as it came up over the mountains on the eastern edge of our valley, creating a silhouette of Thimble Peak. Then, it was as if the moon just popped up and suddenly the entire valley was bathed in moonlight. I loved walking in the desert under its light. The movie, Under the Same Moon, captures the beautiful thought that regardless of where we are in the world, we can look up and know we are under the same moon as those we love.
Anticipation can bring pleasure or anxiety as we are waiting for or pondering a future event. Expectation – like a child waiting for their birthday. But during the Covid Pandemic, there is a sense of anxiety from there being no known end in sight. The anticipation is open-ended and we are unable to plan ahead, which has caused instability in many areas: our health, jobs, housing, food supply. We may anticipate a not-so-good outcome and the future is not predictable or knowable. Not that any of our futures are predictable or knowable, but there are fairly reasonable assumptions we can make when life is close to “normal”.
(Fifth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)
After many years of not having a dog, we decided to adopt one from our local shelter. We found a beautiful German-shepherd/wolf mix who was 18 months old. Bella was docile, sweet and quiet. The next day, as I headed out to the grocery store, I gave her a hug and saw her watch me through the window as I got into the car.
When I returned an hour later, I was met with a shock. I found her, panting rapidly and pacing nervously in our bedroom where our wooden shutters were open and had bite marks. She had tried to escape while I was gone. I had no idea why. I immediately called the shelter. “She is having separation anxiety: she needed to escape being left alone.” We found out that she had been with two families previously when she was dumped at the shelter because she continued to try to escape when she was left alone for hours on end. They gave us the name of a dog behaviorist and we started down the long road of helping Bella manage her fear when we had to leave her at home.
Children and adults can experience separation anxiety when someone they are attached to leaves them. They can have recurrent and excessive distress just anticipating being separated from loved ones and the anxiety can be so intense that it is hard to function in everyday life. Panic attacks and physical symptoms such as nausea and headaches can occur. For me and my husband, on the morning of our son’s death from overdose, standing over our son in that body bag we experienced the ultimate separation anxiety. The overriding emotion we felt was fear: fear of the unknown future we were facing. We couldn’t visualize how we would survive without our son as part of our lives and the future we thought we all had together. He had not only been an integral part of our lives for 25 years but he was literally a part of us–the combination of our DNA that formed him as a particular and unique human being. To say that it was like having part of you taken away doesn’t describe it. This was having our hearts torn out.
We would never embrace or kiss or stroke the cheek of our son again. We were facing an existential crisis, shaken to the core, questioning our reason for living. Regardless of our strong faith that had seen us through many other deaths in our families, this separation seemed incomprehensible and cruel. It was only by falling down on our faces and waiting for Mercy to gradually pick us up that we were able to survive this traumatic separation from our son and move forward again in life.
We are a global community – like it or not. We are connected down to the minutia of life, from what we breathe, to what we eat, to what we think, to what infects us. And right now, the world, our world is in a life-or-death struggle with a microscopic enemy that seems to keep gaining the upper hand. The result in just one area is massive unemployment and the subsequent loss of access and funding for public and private support services.
I don’t want to get in to the politics of whether economies should be opened up regardless of Covid-19 and suffer the consequences in lives lost, verses lives ruined by no work and massive personal and societal debt. What I am concerned about are the consequences of what so many millions of people are facing from having lost their means of livelihood, and in particular, those whose lives were already balanced on a knife edge on a daily basis.
John and I just returned from San Diego where we spoke at the 13th Annual CAHM Forum (Community Alliance for Healthy Mindshttps://www.cahmsd.org/ ). Our dear friends, Rex & Connie Kennemer, began CAHM after their 25-yr-old son, Todd, died by suicide. The theme this year was “The Power of Your Story” and we were among the presenters who shared our story of living with our son and his decade-long battle with opioid addiction. We then led a break-out group where we answered questions and discussed the nature of addiction and treatment.
Some may wonder what an addiction story has to do with a forum on mental health. The answer is simple: everything. Now that we have available data covering decades, the connection between individuals who struggle with the entire spectrum of mental health issues and those who are struggling with any addiction co-exist in almost half of those populations.
According to the National Survey on Drug Use and Health (NSDUH), “45% of people with addiction have a co-occurring mental health disorder. Individuals who frequently abuse drugs or alcohol are likely to develop a co-occurring behavioral or mental health disorder. While it is widely accepted that a mental health disorder can induce a substance addiction – and vice versa – researchers are uncovering what causes both conditions to occur simultaneously.” Continue reading “Mental Health & Addiction”
Is there a particular reason that opioids have such an appeal to Millennials? In an article in the New Yorker Magazine (http://nymag.com/intelligencer/2018/02/americas-opioid-epidemic.html) entitled “The Poison We Pick,” Andrew Sullivan discusses the modern American life that we pioneered and how “epic numbers of American are killing themselves with opioids to escape it.” Sullivan goes on to say: “It is a story of pain and the search for an end to it. It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Just as LSD helps explain the 1960’s, cocaine the 1980’s, and crack the 1990’s, so opium defines this new era. I say era, because this trend will, in all probability, last a very long time. The scale and darkness of this phenomenon is a sign of a civilization in a more acute crisis than we knew, a nation overwhelmed by a warp-speed, postindustrial world, a culture yearning to give up, indifferent to life and death, enraptured by withdrawal and nothingness.” Continue reading “ANXIETY, Part 2: Appeal of Opioids to Millennials”
In the summer of 2005, we discovered our 16 year old son was smoking “BT” ––Black Tar Heroin. A few weeks later, while we were in the midst of his withdrawal and simply putting one foot in front of the other as we searched everywhere trying to find the next step, I was rushed to the ER. After going to bed one night, my heart began racing and pounding out of my chest. After an hour, John called 911. At the hospital, I was given tests to see if I was having a heart attack. No. The diagnosis: extreme anxiety––deep, un-verbalized, foreboding. I was given IV morphine and as my heart rate slowed down, I slept. Who else but our children can affect our hearts at such a fundamental and unconscious level? Continue reading “ANXIETY, Part 1”
The Ohio Society of Addiction Medicine is a chapter of ASAM - A professional society actively seeking to define and expand the field of addiction medicine.
Opiate Nation 