Social Anxiety & Substance Use Disorder Were Linked In A New Study & Here’s What You Should Know

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At one point or another, you’ve probably met someone who identifies as “a social drinker” — you may even identify as one yourself. People drink casually for a host of reasons: to help them unwind, because they enjoy the taste, and even as a “social lubricant” to help feel less awkward and make socializing a little easier. While there’s nothing wrong with responsibly sipping some wine or beer at a party, alcohol also has the potential to be misused, particularly when it comes to dealing with social anxiety. A new study found that social anxiety disorder may be linked to substance use disorder, and specifically alcohol use, that weren’t reflected in other types of anxiety disorders.

Lots of people feel nervous when meeting someone new or entering new social situations, but social anxiety disorder is distinguished by a constant fear towards a variety of social situations where the person “is exposed to unfamiliar people or to possible scrutiny by others,” the National Institute of Mental Health (NIMH) writes. A person with the disorder may be anxious about embarrassing themselves to the point where it interferes with their ability to live their life, and NIMH estimates that roughly 12 percent of American adults experience social anxiety disorder in their lifetime. The new research, published in the journal Depression and Anxiety, focused on understanding how the disorder might affect an individual’s relationship with alcohol and their drinking patterns.

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Researchers interviewed roughly 2,800 adult twins, assessing level of alcohol consumption and mental health factors including panic disorder, specific phobias and agoraphobia, generalized anxiety disorder, and social anxiety disorder. People with the disorder were associated with a higher risk for potentially developing alcoholism later in life, while the other studied anxiety disorders didn’t appear to be risk factors. Alcohol abuse also had the most significant link with social anxiety disorder.

This link is significant because of how it could affect treatment for both disorders. “Many individuals with social anxiety are not in treatment. This means that we have an underutilized potential, not only for reducing the burden of social anxiety, but also for preventing alcohol problems,” study author Dr. Fartein Ask Torvik said in a statement. “Cognitive behavioral therapy with controlled exposure to the feared situations has shown good results.”

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Cognitive behavioral therapy, otherwise known as CBT, is a type of psychotherapy that helps patients by altering patterns of harmful and unhelpful thoughts, behaviors, and emotions. The therapy largely focuses on solutions that help patients question and confront “distorted cognitions and change destructive patterns of behavior,” according to Psychology Today, as well as to develop coping skills. It’s been proven effective as a treatment for a several mental health issues, including anxiety disordersdepression, and eating disorders.

Based on the study results, treating social anxiety and helping prevent it with therapies like CBT could potentially have the benefit of limiting alcohol abuse in patients. The relationship the study pinpointed between excessive drinking and social anxiety suggest further research on the topic is necessary, especially if people are drinking to deal with their mental health instead of seeking mental health treatment.

If you or someone you know is seeking help for substance use, call the SAMHSA National Helpline at 1-800-662-HELP(4357).

Positive Psychology Exercises Increase Happiness In People Recovering From Substance Use

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Positive psychology,Positive psychology exercises,Substance abuse
The study, published in the Journal of Substance Abuse Treatment, examined whether positive psychology exercises increase happiness in people recovering from substance use.(Shutterstock)

Self-administered exercises can significantly boost in-the-moment happiness for adults recovering from substance use disorders, suggests a recent study.

The study, published in the Journal of Substance Abuse Treatment, examined whether positive psychology exercises increase happiness in people recovering from substance use.

“Addiction scientists are increasingly moving beyond the traditional focus on reducing or eliminating substance use by advocating treatment protocols that encompass quality of life. Yet orchestrated positive experiences are rarely incorporated into treatment for those with substance use disorders,” said Bettina B. Hoeppner, lead author of the study.

As part of the study, the authors noted that effectiveness of positive psychology exercises may be promising tools for bolstering happiness during treatment and may help support long-term recovery.

According to lead researchers, the study underlines the importance of offsetting the challenges of recovery with positive experiences. Recovery is hard, and for the effort to be sustainable, positive experiences need to be attainable along the way.

The “Addiction Spectrum” Challenges You To Think About Substance Abuse Differently

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In our culture, we don’t tend to talk about being “a little bit” addicted to something. It’s not like there are AA meetings for people who are “kind of” alcohol dependent, or a treatment plan for someone who is “a little” obsessed with working out.

But a new book, titled The Addiction Spectrum, is rethinking the idea that addiction is so cut and dry. Author Paul Thomas, MD, an addiction medicine specialist and integrative practitioner, argues that addiction is more of a sliding scale that factors in the severity of the addiction as well as life events, genetic predispositions, and other contributing factors. And, he says, this addiction spectrum is just as applicable to things like food or social media as it is to drugs or alcohol.

This is a little different from the other way experts commonly define addiction: as a disease. The Center of Addiction (CoA), the American Psychiatric Association, the American Medical Association, and the American Society of Addiction Medicine (ASAM) all ascribe to this particular view, which has been mainstream in the medical community for decades. “Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” stipulates the ASAM. The CoA compares addiction to diabetes, heart disease, and cancer because “it’s caused by a combination of behavioral, environmental, and biological factors.”

Experts have been thinking about addiction as a disease for a long time. But in his book, Dr. Thomas argues that by classifying addiction as a disease, you’re not getting the full picture of how addiction works—and thus you’re missing out on opportunities to turn around a problematic habit before it gets out of control.

But if addiction is more of a spectrum than a you-are-or-you-aren’t kind of thing, how do you know if you actually have a problem? And what does all this gray area mean for treating substance use disorders? Here, leading addiction experts give all the intel, explaining what you really need to know about addiction—and why you don’t have to hit rock bottom to turn a potentially destructive habit around.

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Photo: Stocksy/Ivan Gener

Understanding the spectrum

Sometimes addiction is obvious—like when it starts affecting your relationships and career—and sometimes it’s more hidden, making it harder to identify. “I use [noise] volume as a metaphor to explain it to people,” says Neeraj Gandotra, MD, the chief medical officer at Delphi Behavioral Health, a national addiction treatment network. “Sometimes it’s a disorder that’s very loud and disruptive, and sometimes it’s more quiet.”

That’s where the addiction spectrum comes in. “The way someone can figure out where they fall on the spectrum is based on the number of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria you meet,” says Samantha Arsenault, the director of national treatment quality initiatives for Shatterproof, a non-profit dedicated to ending the destruction addiction causes. There are 11 different factors that specialists use to determine someone’s place on the addiction spectrum, including how much of the substance a person is taking and how long they’ve been taking it, whether they feel cravings for that substance, and whether it’s causing problems in their relationships.

“Technically, a mild substance abuse disorder means they have two or three different factors,” Arsenault says. Someone in the middle of the spectrum would have four of five of these factors, she says, while a person with a much more severe addiction would have six or more of symptoms. While the DSM-5 is currently used for substances like alcohol, stimulants, cannabis, and opioids, Dr. Thomas says the concept of the addiction spectrum could apply to anything that could potentially turn problematic (like exercise and sugarconsumption).

“The reason why it’s so important to view addiction as a spectrum is because it means you don’t have to hit rock bottom to turn it around.” —Samantha Arsenault, Shatterproof

Interestingly, this fits in well with the ASAM’s viewpoint on unhealthy substance use. While they do define addiction as a disease, the group also says that there is a whole range of behaviors, from low-risk use (where you’re consuming alcohol or drugs below harmful levels) to hazardous use (where you’re consuming these substances in a way that increases the risk of health consequences) and ultimately addiction. Addiction is less about how much of a substance a person uses or how often they use it, and rather the way in which they respond to those substances, the ASAM says.

To put this thinking in context: “I had a client who was a high-powered executive and he would drink a bottle-and-a-half of wine every night after work to de-stress,” says clinical psychologist Kevin Gilliland, PsyD. “But even though he drank a lot, he would always make it to a 6 a.m. workout. Was he on the severe end of the spectrum? Well, not fully, because he’s holding down a good job and to the outside world he’s not destroying his life in any obvious ways. But he was still putting his health at risk and it actually was greatly harming his relationship with his wife, so it was problematic in those ways.”

A generally non-problematic habit, like a daily glass of wine, can potentially get pushed into more dicey territory. “There are factors that could cause someone to creep up on the addiction spectrum, such as genetic predisposition,” Dr. Thomas says—meaning that if someone in your family is an addict, it could make you more likely to develop an addiction, too. “Or if stressful events in your life occur and you’re turning to that glass to relax, it could increase to two, three, or more a night.” He also adds that it’s pretty common for tolerance to increase, so if you’re drinking a glass of wine to get a little buzz, it could morph into needing more to have the same feeling.

This is not at all to say that everyone who drinks a glass of wine a day will always develop an addiction. But something that seems harmless could potentially transform into a destructive pattern, depending on other factors in your life and your genetic makeup.

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Photo: Getty Images/ Petri Oeschger

The varying degrees of addiction

This might seem overwhelming. But changing how we think about addiction—not as an “on-off” switch, but more as a gradient with levels of seriousness—could be helpful when it comes to prevention, at least according to the experts who tout this way of thinking. “The reason why it’s so important to view addiction as a spectrum is because it means you don’t have to hit rock bottom to turn it around,” Arsenault says. “If you’re on the low or medium end of the spectrum, you can look at that and think about the lifestyle changes you can make before it gets worse.”

Since addiction comes in varying degrees, treatment can vary, too. When Dr. Gandotra is working to treat a patient with an addiction, his first thoughts are on their most basic, primary needs. Do they have a place to live? Are they going to be going through withdrawal? Do they need to be enrolled in a rehab program? “Rehab isn’t always the best answer,” he says. “It really does depend on where they are on the spectrum and factors like if they’re able to hold down a job and have familial support.”

He adds that the substance in question matters, too. “There’s a hierarchy in terms of the consequences. Someone using an illicit substance is at risk of being arrested, or using cocaine puts you at risk for sudden death.” Definitely not the same as being addicted to your phone.

For a person on the lower end of the spectrum, the experts say treatment starts with meeting someone where they are, and what they’re willing to change. “Maybe someone isn’t ready to stop drinking alcohol completely, but they can make the step to limit it to every other night [rather than] every night,” Dr. Gandotra says. “It also allows for the chance to tweak the script a little bit and ask them, ‘Is there any aspect of your drinking you would like to change?’ That can help someone figure out where to start.”

However, in the case of someone with a severe addiction (or a person who is addicted to a life-threatening substance), quitting cold turkey is necessary. “If someone is on the severe end of the spectrum, the physical symptoms need to be addressed first. Then, the lifestyle changes can be addressed,” says Dr. Thomas.

“What I’m really hoping to get across by talking about addiction as a spectrum is, again, you don’t have to hit rock bottom to change,” adds Dr. Thomas. “Maybe your relationship with alcohol, food, screen-time—whatever it is—isn’t as healthy as you would want it to be. You don’t have to reach a tipping point to change it.”

Here’s what you need to know about exercise addiction. And if you’re recovering from an eating disorder, approaching wellness can be tricky. Here’s how to do it.

The Perverse Link Between ADHD and Addiction

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Credit: Marine Corps.

While the exact number of adults with ADHD is unknown, it is estimated that 4% of the U.S. adult population is affected by ADHD. While most people can function very well and become successful despite their condition, ADHD is also associated with life-long impairments in several facets of life, including educational and professional achievements, self-image and interpersonal relationships. But one of the darkest sides of ADHD is its propensity for addiction.

Why ADHD can lead to substance abuse

Addiction is a global problem that affects people from all walks of life, irrespective of gender, financial status, skin color, sexual orientation, religion, or spiritual practice. According to the American Society of Addiction Medicine (ASAM), addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” which leads to dysfunctional behavior in order to provoke relief in spite of the negative consequences a person may attract.

“Addiction is an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” according to a characterization on the ASAM website.

It’s these changes in the brain that make addiction so dangerous, causing a person to lose control over his or her use of substances. This also leads to subsequent problems at work, in relationships, and with one’s sense of self-worth and esteem.

Some people are more vulnerable to addiction than others. One primary factor which specialists have identified are adverse childhood experiences, which create their own brain changes. Research has also identified neurological conditions that make people prone to addiction, ADHD being one of them.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome characterized by persistent patterns of inattention and/or impulsivity and hyperactivity that is inappropriate for a given age or developmental stage. The exact causes of ADHD are still unknown but the evidence so far suggests that dopamine neurotransmission dysfunction is at least partially responsible for the disorder’s symptoms. This dopamine link may also explain why ADHD often co-occurs with substance use disorders.

Symptoms of ADHD across lifespan. Credit: ADHD Institute.

The risk of drug and substance abuse is significantly increased in adults with persisting ADHD symptoms who have not been receiving medication.According to one study, ADHD is associated with a twofold increase in the risk of psychoactive substance use disorder. In addition, it is estimated that more than 25% of substance-abusing adolescents meet diagnostic criteria for ADHD. A 2004 survey found that 60% of the adults with ADHD have been addicted to tobacco while 52% have used drugs recreationally.

“One of the strongest predictors of substance use disorders in adulthood is the early use of substances, and children and teens with ADHD have an increased likelihood of using substances at an early age,” Dr. Jeff Temple, a licensed psychologist and director of behavioral health and research in the department of obstetrics and gynaecology at the University of Texas Medical Branch, told Health Line.

Bearing all of this in mind, clinicians working with patients that suffer from both ADHD and substance abuse may need to use a different approach than they would normally. While the treatment literature for ADHD in patients with substance use disorder is not well developed, the emerging trend is that medications effective for adult ADHD may be effective for adults with ADHD and co-occurring substance use disorder. Exercising regularly and having behavioral health checkups during treatment are also important.

The key seems to be starting ADHD treatment as early as possible, before a person has the chance to develop a substance use disorder during his or her teens. Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. However, it is essential that ADHD treatment begins when the patient is sober, so some drug or alcohol detox may be required before treatment.

“A conservative approach for treating co-occurring ADHD and SUD would be to begin treatment with a non-stimulant pharmacotherapy, but if an adequate response is not obtained, consider stimulant pharmacotherapy. The decision regarding the use of stimulant medications for a patient with ADHD and a co-occurring substance use disorder should be made on the basis of a broad clinical assessment and an individual risk-benefit analysis. For many patients, psychostimulants can be used safely and effectively; however, careful monitoring during treatment is essential to ensure prescribed stimulants are being used in a therapeutic manner, and in the case of worsening substance use or when faced with evidence of the diversion of prescribed medication, treatment should be discontinued,” according to researchers at the New York State Psychiatric Institute.

Your Genes and Addiction

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Over the last decade, the prevalence of opioid addiction has increased to epidemic levels, but unfortunately therapeutic interventions for the treatment of addiction remain limited. We need to better understand the triggers for the development of addiction in order to develop more targeted prevention and treatments. One of the key questions that researchers in the field of neuropsychiatry are trying to answer is why some people are more vulnerable to addiction. As in most cases of psychiatric disorders, genetic and environmental factors interact to determine how vulnerable, or likely, you are to developing a substance use disorder.

Drugs of abuse, including opioids, act on the brain’s reward system, a system that transfers signals primarily via a molecule (neurotransmitter) called dopamine. The function of this system is affected by genetic and environmental factors. For example, a recent study published in the scientific journal PNAS revealed one of those genetic factors. Researchers demonstrated that a type of small infectious agent (a type of RNA virus called human endogenous retrovirus-K HML-2, or HK2) integrates within a gene that regulates activity of dopamine. This integration is more frequently found in people with substance use disorders, and is associated with drug addiction.

How does stress induce epigenetic changes?

Accumulating evidence suggests that environmental factors, such as stress, induce epigenetic changes that can trigger the development of psychiatric disorders and drug addiction. Epigenetic changes refer to regulations of gene expression that do not involve alterations in the sequence of the genetic material (DNA) itself. Practically, epigenetic changes are information that is added on to already existing genetic material, but can affect the expression of genes.

A stressful situation, such as the death of a significant other or the loss of a job, triggers the release of steroid hormones called glucocorticoids. Those stress hormones trigger alterations in many systems throughout the body, induce epigenetic changes, and regulate the expression of other genes in the brain. One of the systems that is affected by stress hormones is the brain’s reward circuitry. The interaction between stress hormones and the reward system can trigger the development of addiction, as well as a stress-induced relapse in drug or alcohol recovery.

Stress reduction can help reduce the risk of developing an addiction and prevent relapse

Fortunately, the negative effects of stress can be alleviated by other factors, such as physical activity or social support. These behaviors produce epigenetic changes that prevent the development of addiction and can have a beneficial role in treatment when used in combination with other interventions, such as cognitive behavioral therapy and, for some people, medications. One of the ways that physical activity could be effective is by reducing negative feelings, including stress and the accompanied stress-induced epigenetic changes. In the example of a stressful situation such as the death of a significant other or loss of a job, if a person engages in physical activity this can reduce their stress-induced epigenetic changes, which will decrease the risk of developing addiction or stress-induced relapse.

Hope for targeted addiction treatments

We now know that the function and dysfunction of the brain’s reward system is complicated, plastic (undergoes changes based on negative and positive factors), and involves complex interactions of genetic and environmental factors. Alterations in gene expression can lead to changes in the function of the brain’s reward system, so a person is more or less likely to self-administer drugs. Together this knowledge can ultimately lead to the development of multilevel and more efficient prevention and therapeutic approaches to address the ongoing opioid epidemic.

Resources

Human Endogenous Retrovirus-K HML-2 integration within RASGRF2 is associated with intravenous drug abuse and modulates transcription in a cell-line modelProceedings of the National Academy of Sciences, September 24, 2018.

What Makes Addiction a Disease?

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Philadelphia's Kensington neighborhood has been called “ground zero” in the battle against opioid addiction. (Kimberly Paynter/WHYY)
Philadelphia’s Kensington neighborhood has been called “ground zero” in the battle against opioid addiction. (Kimberly Paynter/WHYY)

Philadelphia’s Kensington neighborhood has been hit hard by the national opioid crisis that’s killed tens of thousands of Americans in recent years.

One morning in July, here’s the scene outside a neighborhood train station: While an ambulance winds its way through traffic nearby, people sit on the stairs with their heads buried in their arms. Others hustle for spare change or hawk “works” — street slang for a syringe. Several of the drug users stand stooped, their bodies droop then jerk back up again in the rhythm of a heroin nod.

At this spot, less than a week earlier, six people overdosed in the span of 15 minutes.

“It’s like watching TV,” said local resident Cano Gomez. “You stand here and it’s like watching a whole reality show, a one-hour reality show, to stand out here. I’m telling you man, it’s crazy.”

For people addicted on the streets, overdosing is just one worry on a long list of hardships. Many have lost their homes, jobs and families. They’ve seen friends die and get locked up. And when they try to explain how all of this happened, many say they are sick.

“I’m a freakin’ addict, I got a disease man,” said Salvatore Gonzalez, Jr., who’d been living in a Philadelphia homeless encampment.

Salvatore Gonzalez, Jr. and his fiancée stand near the Kensington Avenue railroad overpass in Philadelphia, Pa. (Emma Lee/WHYY)

No matter who is talking about addiction these days, chances are they are using that term: “disease.”

From former President Barack Obama, to former New Jersey Governor Chris Christie, to President Donald Trump, politicians on both sides of the aisle now talk about addiction as a public health issue.

“This epidemic is a national health emergency,” Trump declared less than a year into his presidency.

There’s a growing consensus that addiction is a disease of the brain that requires medical treatment. Among consensus are people in recovery, their advocates, and police.

It feels like a far cry from the days when conventional wisdom viewed addiction as a moral failing that called for criminal punishment.

But calling addiction a brain disease, and not a bad life choice, is still a fairly new concept — one that has been built up over the past few decades by researchers toiling to understand how addiction affects the brain. As that view gains wider acceptance, some critics are challenging whether it’s really appropriate to call addiction a “brain disease.”

A rewired reward system

Charles O’Brien, a professor of psychiatry at the University of Pennsylvania, has been doing research on addiction since the 1960s. He says back then, psychiatrists tended to view drug addicts as, essentially, psychopaths.

“It was related to antisocial personality, and that’s not really true,” O’Brien said.

Researchers did know that the body could become dependent on a drug over time. And with new technologies, O’Brien and his colleagues were able to see the impact drugs had on the brain.

“Beginning in the 1980s, we started doing brain imaging, and we developed cues that were associated with drug use,” he said.

The cues were pictures of things like drug paraphernalia, or a syringe jabbed into a forearm. When O’Brien showed these pictures to people who had a history of addiction and scanned their brains, the effects were astounding.

“People thought that I was giving drugs to my patients in the laboratory, and I wasn’t,” O’Brien said.

The pictures were enough to activate parts of the brain that form what’s known as the “reward system.” They were the same areas that would light up if the person had, say, snorted a line of cocaine.

“Drugs like heroin or alcohol can take over that system,” O’Brien said. “People use the term ‘hijack.’ ”

The reward system is the brain circuitry that gives us a motivating hit of pleasure when we get the things that we need to survive, such as food, sex, and social connection. But drugs deliver a reward that’s much more powerful than those so-called “natural” rewards. When someone becomes addicted, the drug rewards begin to drown out the natural rewards, and the brain gets wired to seek the drug above anything else.

O’Brien’s brain imaging research revealed one very important way the brain gets rewired: people developed a conditioned response to things they associated with their drug use that mimicked the effects of getting high. So even just the sight of a needle or a bottle could trigger powerful cravings that could make it almost irresistible to start using again, even long after someone’s gotten clean.

“They relapse because it’s still in their brain,” O’Brien said.

His finding helped explain the hallmarks of addiction: how people almost always relapse, and keep using drugs despite the often devastating personal costs. The work provided a scientific basis for calling addiction a brain disease.

Scientists continue to build on this discovery to better understand the complicated — and sometimes unexpected — ways that addiction affects the brain.

What cute babies can tell us

In a basement laboratory at the University of Pennsylvania, psychiatrist Daniel Langleben uses a giant fMRI machine to see inside the brains of people recovering from addiction.

As a 25-year-old mother — who’s in treatment for opioid addiction — lies inside, researchers show her a series of baby photos while the machine scans the woman’s brain.

“The task involves you being asked to either rate how cute is the baby, or to what extent you would like to take care of it,” said Langleben, a research professor at the university.

As it turns out, these cute babies can activate the same part of the brain’s reward system that lights up when people use drugs.

“Specifically it’s called nucleus accumbens,” Langleben said. “It’s a very, very small area, deep inside the brain.”

He’s done other research showing that the nucleus accumbens responds to the unique features of an infant’s face, which are called “baby schema.”

“Big eyes relative to the face for example, large forehead, small chin — all these things that will tell you this is a baby,” Langleben said.

Research suggests that our brains are wired to get a motivating hit of pleasure just from seeing baby schema, he says.

“The hypothesis is that it is made to be rewarding exactly because nature needs us to take care of the young,” Langleben said.

But opioid addiction could make people less sensitive to baby schema. So he’s testing whether a participant’s response to those cute babies changes as they progress through addiction treatment, and whether that correlates with better parenting.

Brain research has helped to explain the cravings and relapse people experience in addiction, and this new frontier of research Langleben is involved in may shed light on some of the social consequences, such as neglecting childcare. Science has moved our understanding of addiction out of the realm of morality and into the medical world, as a disease that can be treated.

That has reduced stigma, and helped expand access to more effective forms of treatment that use medication to tamp down cravings and withdrawal. The federal government, for example, is spending billions of dollars on medication-assisted treatment to alleviate the opioid crisis.

Nevertheless, the “brain disease” definition of addiction has attracted plenty of critics.

“Unbroken Brain”?

Sally Satel, a psychiatrist in Washington, D.C., and lecturer at Yale School of Medicine, doesn’t contest the science on how addiction affects the brain. But she still takes issue with calling it a “brain disease.”

Satel says addiction isn’t like catching an infection, or a defect that spontaneously appears in the brain. To make her point, she draws a comparison with Alzheimer’s disease. It would be “meaningless,” she said, to ask someone with a brain disease like Alzheimer’s why they have the condition.

“But if I were to ask you why do you drink too much, why are you using heroin everyday, that’s a meaningful question,” Satel said. “And it goes to the fact that people use drugs for reasons.”

That makes her skeptical that interventions such as medication are really enough to help people stay in recovery.

“A lot of people still want to alter their consciousness, they’re in a lot of psychic pain,” Satel said.

Another critic is trying to reconcile addiction’s roots in both biology and behavior. Maia Szalavitz, a journalist who’s been covering addiction for 30 years, was addicted to drugs herself when she was in college.

She’s also a self-described “deadhead,” a devotee of the legendary rock band The Grateful Dead.

In her book, “Unbroken Brain” — a play on the title of one of the band’s songs — she writes about her first time doing cocaine, at age 17, with Jerry Garcia, the front man of the group.

“I sort of had the kind of hippie attitude of like, ‘white powders are bad,’ but you know if Jerry offers you a line you’re gonna do it,” Szalavitz said.

A few years later, she got busted for cocaine possession. It was a wake-up call. Soon she entered treatment and began her recovery.

Szalavitz says you can’t blame Garcia for all of that, though. She’d already experimented with other substances at that point. The druggy music scene she was a part of in the 80s gave her a sense of identity, and the chemicals themselves relieved her social anxiety.

“Generally 90 percent of addictions happen in the teen and young adult [years],” Szalavitz said. “That’s a sensitive period of brain development.”

For Szalavitz, addiction is not a brain disease, exactly. In her book, she takes a deep dive into modern addiction science and makes a case that addiction is fundamentally about learning. She offers the example of what can happen when people are put on opioids in the hospital after surgery.

“There are people who become physically dependent on opioids in the hospital for pain, and they don’t know it,” she said. “And they go home, and they feel like they have the flu […] they never realized that they had a physical dependence on an opioid.”

Eventually, the opioid withdrawal symptoms pass and they go on with their lives, Szalavitz says.

“If you don’t learn that a drug fixes some kind of problem for you, you can’t be addicted to it because you wouldn’t know what to crave,” she said.

Maia Szalavitz, author of “Unbroken Brain” has been covering addiction for 30 years. (Joel Wolfram/For WHYY)

Szalavitz says the way that compulsive drug use is learned isn’t given enough weight when we label addiction a brain disease. She thinks it should take center stage. The gist of her argument goes back to those baby photos researcher Daniel Langleben was showing to former opioid users. Szalavitz says the connection between opioid addiction and the way we can become obsessed with a cute baby is key to the story of what addiction really is.

The same holds for other human relationships, she says. A lover’s touch, a friend’s reassuring presence, a happy baby cradled in your arms — all of these moments are rewarded by naturally occurring opioid neurotransmitters in the brain.

“What opioids do in the brain when they’re not relieving pain is they are there to create social bonds,” Szalavitz said.

When we don’t abandon an infant that throws up on us and cries through the night, or continue to chase a love interest after a crushing rejection, Szalavitz points out that these behaviors look a lot like addiction.

“People with addiction are persisting despite negative consequences in a way that’s necessary for human survival,” she said. “We evolved this thing for a reason, because it’s hard to deal with people, and babies are a pain in the butt, and they cry and you have to change them, and you have to persist if you are going to survive and reproduce successfully, right?”

Szalavitz says people have learned to love the wrong rewards.

Plus, she says, to understand why people want to alter their experience with chemicals in the first place, you have to look outside the brain.

“Trauma is one of the other big factors,” Szalavitz said. “About two thirds of people with addiction have at least one childhood trauma.”

There’s also socioeconomic factors that contribute.

“Unemployment, poverty, kind of being socially disconnected,” she said. “There are very few people with addiction who have none of those elements.”

Szalavitz says the way we talk about addiction now, as a brain disease, misses the mark. But she says it’s not so much the words that matter, but what exactly we mean when we say them.

“I just want people to understand that this is a learned behavior in which a system that is there for essential survival and reproduction stuff goes in the wrong direction,” Szalavitz said. “It’s not an inhuman behavior, it’s not about evil, manipulative, horrible, lying people.”

This story was made possible in part thanks to a grant from the Scattergood Behavioral Health Foundation.

It is a well known fact that those that suffer from PTSD are at a much higher risk for falling into substance abuse. Many people with PTSD often find themselves going for the bottle or something else harmful to help quickly find relief from their pain. But could early substance abuse actually lead to PTSD? […]

via Could Substance Abuse be Causing PTSD? — Beva’s PTSD Blog

Marijuana Access Is Associated With Decreased Use Of Alcohol, Tobacco And Other Prescription Drugs

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By Paul Armentano

A significant amount of data has been generated in recent years showing that cannabis access is associated with reduced levels of opioid use and abuse. But emerging data also indicates that many patients similarly substitute marijuana for a variety of other substances, including alcohol, tobacco and benzodiazepines.

Last month, a team of researchers from Canada and the United States surveyed over 2,000 federally registered medical cannabis patients with regard to their use of cannabis and other substances. (Medical cannabis access has been legal across Canada for nearly two decades).

Investigators reported that nearly 70 percent of respondents said that they substituted cannabis for prescription medications, primarily opioids. Forty-five percent of those surveyed acknowledged substituting cannabis for alcohol and 31 percent of respondents said that they used marijuana in place of tobacco.

Among those who reported replacing alcohol with cannabis, 31 percent said they stopped using booze altogether, while 37 percent reported reducing their intake by at least 75 percent. Fifty-one percent of those who reported substituting cannabis for tobacco said that they eventually ceased their tobacco use completely.

 

This documentation of cannabis substitution is not unique. A 2017 study of medical cannabis patients similarly reported that 25 percent of the cohort reported substituting cannabis for alcohol, while 12 percent substituted it for tobacco. A 2015 paper published in the journal, “Drug and Alcohol Review” also reported that over half of patients surveyed substituted marijuana in lieu of alcohol. A placebo-controlled clinical trialperformed by researchers at London’s University College reported that the inhalation of CBD — a primary component in cannabis — is associated with a 40 percent reduction in cigarette consumption.

Numerous studies also indicate that legal cannabis access is associated with reductions in overall prescription drug spending. While much of this reduction is the result of the reduced use of opioids, studies also report decreases in patients’ consumption of other prescription drugs, such as sleep aids, anti-depressants and anti-anxiety medications. A 2019 study by a team of Canadian researchers reported that the use of marijuana is associated with the discontinuation of benzodiazepines. (The popular anti-anxiety medication was responsible for over 11,500 overdose deathsin the United States in 2017, according to the US Centers for Disease Control). In their study of 146 subjects, the initiation of medical cannabis resulted in significant and sustained reductions in patients’ use of the drug.

By the trial’s conclusion, 45 percent of participants had ceased their use of benzodiazepines. In a separate study, also published this year, of over 1,300 US medical cannabis patients suffering from chronic pain conditions, 22 percent reported substituting marijuana for benzodiazepines.

These scientific findings run contrary to the so-called “gateway theory” – the long-alleged notion that marijuana exposure primes users to ultimately engage in the use of far more intoxicating and addictive substances. By contrast, for many people cannabis appears to act as an “exit drug” away from potentially deadly pharmaceuticals, booze, cigarettes and even other illicit substances such as cocaine.

As more jurisdictions move away from cannabis prohibition and toward a system of regulated access it will important to monitor the degree to which these trends continue and to assess their long-term impacts on public health and safety.

Paul Armentano is the deputy director of NORML — the National Organization for the Reform of Marijuana Laws. He is the co-author of the book, Marijuana Is Safer: So Why Are We Driving People to Drink? and the author of the book, The Citizen’s Guide to State-By-State Marijuana.  Laws.

Oregon Lawmaker Seeks $2 Million For Mental Health Centers

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By Elliot Njus

The Oregon Senate’s Housing Committee advanced a bill that would enact a statewide rent control policy and restrict evictions, sending it to the full Senate for a vote.

Lawmakers heard nearly four hours of testimony from renters and landlords as Senate Bill 608 had its first hearing in the Senate’s Housing Committee. It’s poised to cruise through the Legislature, with support from leaders of the Democratic majority in both the House and Senate.

Oregon lawmakers propose unorthodox approach to rent control

Oregon lawmakers propose unorthodox approach to rent control

Their proposal attempts to sidestep longstanding criticism of the polarizing policy, but it’s also drawn some misgivings from rent control supporters.

Two landlord groups, the Rental Housing Alliance Oregon and the Oregon Rental Housing Association, are both remaining neutral, with their leaders saying the bill is palatable, if not appealing.

That’s a relatively friendly position for their constituency – both statewide advocacy groups geared toward small landlords.

“There’s a lot here for landlords to dislike,” said Jim Straub, the legislative director for the Oregon Rental Housing Association. “But I’d also like to recognize it for what it isn’t: an industry killer. As written, I do not believe it will be catastrophic to our livelihood.”

The larger Multifamily NW, whose Portland-area membership includes larger landlords and property management companies, opposes the bill, as did many landlords who testified on their own behalf. They argued it would hurt business and discourage investment, resulting in substandard housing.

They pointed to a large body of academic research that’s found rent control policies in other states have resulted in a reduced housing supply and higher rents.

“At best, Senate Bill 608 will have no effect,” said Deborah Imse, the executive director of Multifamily NW, “but at worst it will make housing less affordable in the long run.”

Renters and tenants’ rights activists largely argued the bill would help protect against eye-popping rent increases that have frequently grabbed headlines across the state.

“It doesn’t solve the entire problem,” said Katrina Holland, the executive director of the Community Alliance of Tenants. “It certainly does take a giant leap forward by giving a measure of predictability for hundreds of thousands of renters in hundreds of cities across the state.”

Senate Republicans on Monday released statements in opposition to the proposal.

The bill would cap annual rent increases to 7 percent plus inflation throughout the state — a rate that’s much higher than most municipal rent control policies in other states. In many California communities with rent control, for example, affected apartments see their rents climb only by the rate of inflation, or a fraction of it, each year. (Annual increases in the Consumer Price Index, a measure of inflation, for western states has ranged from just under 1 percent to 3.6 percent over the past five years.)

The rent increase restrictions would exempt new construction for 15 years, and landlords would be free to raise rent without any cap if a renter left of their own accord. Subsidized rent would also be exempt.

The bill also would require most landlords to cite a cause, such as failure to pay rent or other lease violation, when evicting renters after the first year of tenancy.

Some “landlord-based” for-cause evictions would be allowed, including the landlord moving in or a major renovation. In those cases, landlords would have to provide 90 days’ notice and pay one month’s rent to the tenant, though landlords with four or fewer units would be exempt from the payment.

The bill would not lift the state ban on cities implementing their own, more restrictive rent control policies.

Sen. Fred Girod, R-Stayton, the ranking Republican on the Senate Housing Committee, said Senate Democrats flatly rejected a suite of amendments, including the removal of an emergency clause. With the clause, the bill would take effect when it’s signed by the governor; if passed without it, the bill would take effect next year. Girod abruptly left the hearing after it became clear the amendments would not pass.

Sen. Tim Knopp, R-Bend, the only Republican remaining after Girod left, cast the lone “no” vote.

“We’re making policy that ultimately going to be counterproductive to hat all the people who testified said they actually want,” Knopp said.

Sen. Shemia Fagan, D-Portland, who chairs the housing committee, said she shared concerns from people who testified it doesn’t go far enough.

“I wish this bill would do more, and I would be willing to go further,” she said.

— Elliot Njus

Why Mental Illness Is Surging Even In The World’s Happiest Countries

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By SOPHIE MCBAIN

In recent decades, economists studying life satisfaction have noticed a pattern – one that is remarkably persistent across different countries and cultures. Most people’s happiness levels begin dipping in adulthood, bottoming out when they reach their forties and fifties, before rising again.

This link between age and life satisfaction is known as the happiness curve. For discontented Generation Xers, it may provide relief to know that the midlife crisis is real but temporary, and that things will most likely get better. Young people might think rather differently, however. Could they feel any worse?

In both the US and the UK there has been a disquieting rise in depression, anxiety and other forms of distress among young people. Last April, a survey of more than 2,000 Britons aged 16-25 conducted by the youth charity the Prince’s Trust found that half had experienced a mental health problem, one in four said they felt “hopeless” and almost half felt they could not cope well with setbacks in life. The number of students dropping out of British universities because of mental health problems, and the number of campus suicides, have reached record highs. Similarly, a 2017 survey of 63,500 US college students found that 39 per cent had felt “so depressed it was difficult to function”. Between 2008 and 2015, the number of hospitalisations of suicidal teens doubled in America.

There are many economic and structural reasons why American and British teens might be struggling to cope. Inequality is rising, social mobility is stalling, competition for high-ranking universities and well-paid jobs is becoming fiercer. Yet this remains an insufficient explanation.

Last year, the Nordic Council of Ministers, an inter-parliamentary group comprised of representatives from Denmark, Finland, Iceland, Norway, Sweden, as well as several autonomous islands, released a report titled In the Shadow of Happiness. The Nordic countries consistently top the United Nations’ world happiness rankings, which is often attributed to their egalitarianism, extensive welfare states and work-life balance. But the Council wanted to examine a population that is overlooked in glowing UN reports: in the happiest countries in the world, who is sad?

It transpired that the populations most likely to be suffering or struggling emotionally were the very old (those over 80) and the young. The report found that 13.5 per cent of 18- to 23-year-olds in the Nordic states rated their life satisfaction as less than six out of ten, which means they are either struggling or suffering. The primary cause of this discontent, the authors concluded, was the rising rate of youth mental illness. In Norway, the number of young people seeking help for mental illness increased 40 per cent in five years. In Finland, named the happiest country in the world for 2018, suicide is responsible for a third of all deaths among 15- to 24-year-olds.

In her 2017 book iGen, Jean Twenge, an American psychologist, attributed the sharp increase in mental illness among young people to the proliferation of smartphones and the rise of social media. She noted that in the US, youth mental illness rose steeply from 2012 onwards, the year that more than half the population gained access to a smartphone. Perhaps the use of smartphones helps explain the similar trends observed among Nordic teens.

Twenge’s research found that the more time teenagers spend on social media, the more likely they are to report feeling unhappy or depressed. One of her studies found that teens who spend more than three hours a day using electronic devices were 35 per cent more likely to present a risk factor for suicide (such as having made plans to end their life). If modern technology is a prime culprit, then researchers should be worrying about teens in poorer countries too, where smartphone use is spreading but people are often less likely to report mental illness.

Mental illness is complex and there is unlikely to be merely one reason so many young people worldwide are miserable – or any simple solutions. Banning smartphones and social media would be neither practical nor effective: research shows that social media can also increase happiness. Yet finding ways to protect young people from the harmful effects of digital culture could save lives – and might benefit miserable middle-aged people too.