We Can’t Treat Cancer in 30 Days. Why Do We Think Treating Addiction is Any Different?

I’ve tried to verify who came up with the idea that addiction* could be treated in 30 days. One version was reported by Shari Roan in her November 10, 2008 Los-Angeles Times article, “The 30-day Myth,” in which she wrote,

Dr. David Lewis…who in the 1970s helped establish the first addiction treatment program in the U.S. Air Force, says 30-day stays were scheduled for bureaucratic reasons — men and women didn’t need to be reassigned if they were away from duty for no more than 30 days. Other treatment centers followed suit, and insurers adopted the standard of 28 or 30 days of inpatient care. 

In Ben Allen’s story for NPR’s October 1, 2016, Weekend Edition Saturday, titled, How We Got Here: Treating Addiction in 28 Days, Allen quotes Anne Fletcher, author of the book Inside Rehab,

“It certainly is not scientifically based,” she [Fletcher] says. “I live in Minnesota where the model was developed and a lot of treatment across the country really stemmed from that.”

She says the late Daniel Anderson was one of the primary architects of the “Minnesota model,” which became the prevailing treatment protocol for addiction specialists. At a state hospital in Minnesota in the 1950s, Anderson saw alcoholics living in locked wards, leaving only to be put to work on a farm.

To find a path for them to get sober and leave the hospital, he came up with the 28-day model.

However this 30-day version came to be, it’d ludicrous to think addiction can be treated / cured in 30 days given what we now know about this brain disease. Thus, it’s time we start treating addiction the same way we treat other chronic diseases. Please consider these suggestions…

Make Addiction Treatment Readily Available – the Same Way a Person with Heart Disease Is Able To Access the Treatment They Need

We Can't Treat Cancer in 30 Days. Why Do We Think Treating Addiction is Any Different?

Treat Addiction Like Other Chronic Diseases — it can’t be done in 30 days.

Requiring a person with heart disease to wait for treatment is impossible to imagine. It just wouldn’t happen. And, yet, people with a different chronic disease – the brain disease of addiction (aka substance use disorder) – experience this situation ALL THE TIME.

Not only that, trying to figure out where to go or take a loved one in the downward spiral of addiction, a spiral that can result in death, is overwhelming. And then, there’s the cost and what is and is not covered by insurance and the lack of understanding of what a person is supposed to look for in order to treat addiction that can slam the door shut on the moment the person with addiction has decided they need help.

And don’t even get me started on the notion that a person has to hit bottom before they can treat their addiction or that the first line of defense – a person’s primary care doctor – generally has little medical understanding, let alone medical school training, on how to screen for addiction based on symptoms and then make a referral to a medically trained addiction-specialist (of which there are few), the same way they’d screen and refer in the case of diabetes, heart disease, or cancer.

Would we even think of telling a person with diabetes, heart disease, or cancer, “I’m sorry, you haven’t hit bottom, yet, come back when you have.” Or, “Sure, we’ll take you, but no we don’t have a medical, science-based, treatment protocol in place, nor do we have the medical team that can diagnose and treat your chronic, often relapsing brain disease (the one that may be co-occurring with a mental disorder), but we do have peer support group meetings, comfortable accommodations, a top-notch chef, yoga, and exercise programs.”  Now don’t get me wrong…all of the latter are definitely components of a treatment plan that can work for some people. And let me also be clear here, millions of people have succeeded in recovery from addiction solely or in part through participation in a 12-step program or another peer support group. But like treating diabetes, heart disease, or cancer, it may take a medical evaluation and using the latest scientific research to best treat the complexities of addiction (aka substance use disorder) as it presents in other individuals, and for that reason, we must be aware of these complexities. There is no single way a person develops addiction, nor is there a single way to treat all people who have it. (Suggestions offered later in this post.)

And something else to understand, relapse can be part of this disease’s treatment/recovery process, as is true for diabetes, heart disease, or cancer. If, for example, a person with one of these other three chronic diseases relapses (has another heart attack or their cancer returns or they go into a diabetic coma), they are never blamed and told, “Sorry, you must not have wanted it (recovery) badly enough.” Instead, their treatment program is revised because what s/he has been doing isn’t working for them any longer! This same approach must be taken to effectively treat addiction.

Which leads me to my other suggestions…

Treat Addiction Like Other Chronic Diseases

Disease by its simplest definition is something that changes cells in a negative way. When cells change in a body organ, the health and functioning of that organ changes. In the case of lung cancer, for example, cancer cells in the lungs change the health and functioning of the lungs. Addiction changes cells in the brain, which in turn changes the health and functioning of the brain. Given the brain is the organ that controls everything a person thinks, feels, says and does, and develops as the result of contributing risk factors and brain developmental processes that influence that particular person’s brain wiring and mapping, it is now understood that addiction is a complex brain disease. But it is a disease and like other chronic diseases, it’s treatable.

One of the difficulties for accepting this disease model of addiction vs. lung cancer, for example, are the symptoms. With lung cancer, the symptoms might be a cough (often with blood), chest pain, wheezing, and weight loss. The symptoms of addiction include: lying, cheating, verbal/physical/emotional abuse of loved ones, neglect, denying the use or blaming someone or something else for the use/misuse, drinking or using huge quantities of other drugs (far more than “normal” people), and repeatedly breaking promises to stop or cut down. These symptoms make it very difficult to feel sorry for or want to help the person exhibiting them.

So what can we do?

The same thing we do with other chronic diseases. We turn to the latest science and medical research and recommendations to understand the disease and learn what it takes to treat it. And like other chronic diseases, we accept there is no one, nor right, way to treat it. What works for one person may not work for another, and generally it’s a combination of things that can help. And like other chronic diseases, we accept that a relapse doesn’t mean treatment failed, it means treatment needs to be adjusted.

And like other chronic diseases, we take the 3-stage disease management approach to treatment:

  • Stage 1: detox/stabilization
  • Stage 2: acute care/rehab
  • Stage 3: long-term continuing care.

In other words, we do what we’d do for the person presenting with a heart attack, which is: stage 1: stabilize the heart; stage 2: conduct a thorough medical evaluation to determine the best course of action – a bypass, for example, and then we conduct surgery (acute care) and keep them in the hospital while they get used to their new heart (rehab); and stage 3: send them home with a continuing care plan that may include medication, exercise, diet modification, therapy around their fear of it happening again, AND we monitor them, and if something goes wrong, we adjust their treatment, and we NEVER blame them for the reoccurrence. This is not to say everyone with addiction needs to go into detox for their stage 1 or into residential rehab for their stage 2 to be considered “in treatment.” Rather it’s the idea that treatment and recovery is a process that involves all three stage concepts.

Understand How a Person Develops addiction

As I stated above, there are risk factors and brain developmental processes that contribute to a person developing addiction. These include:

Childhood Trauma - Substance Misuse Connection is more easily understood when we understand how the brain develops and what influences that development.

Childhood Trauma | ACEs and the Substance Misuse Connection is more easily understood when we understand how the brain develops and what influences that development.

  • genetics (one can’t help their genetics, but it explains a big piece of the puzzle of how one person develops addiction and another does not when both are using/misusing the same amount – in fact, genetics is 40-60% of the reason a person misusing alcohol or other drugs goes on to develop addiction);
  • childhood trauma (verbal, physical, emotional abuse, neglect…for some this is also ACEs – adverse childhood experiences) which resulted in toxic stress, which can change a child’s brain wiring (brain architecture), and if not addressed during treatment and continuing care is often a trigger to relapse);
  • social environment;
  • mental disorder (also a brain disorder and one that needs to be addressed if it’s still present [co-occurring] so as not to be a relapse trigger to use/misuse because of the mapping of the substance as a soother of the symptoms of the mental disorder – 40% of persons with addiction have a co-occurring mental disorder); and
  • early use (the brain developmental processes occurring from ages 12 – 25 are deeply influencial in the development of addiction in the person misusing alcohol or other drugs during this time).

Then you add the characteristics of addiction (in other words, what makes it different than substance abuse): tolerance, physical dependence, cravings, and loss of control that also need to be addressed, and you can more fully appreciate what I mean – it’s complex 🙂

Pay Particular Attention to Trauma | ACEs (Adverse Childhood Experiences)

Above, I briefly talked about childhood trauma | Adverse Childhood Experiences (ACEs) as one of the key risk factors for developing addiction. Time and again when I speak before audiences or talk one-on-one with individuals or engage in conversations with therapists and other medical professionals, the answer is, “No,” when I ask, “Have you heard of the ACE Study?” This continues to surprise and sadden me because the ACE Study was conducted in the late 1990s, and yet, understanding and using this Study’s findings can have a profound impact on a person’s treatment and recovery success.

In her interview of Dr. Dan Sumrok for her article, “Addiction doc says: It’s not the Drugs. It’s the ACEs — adverse childhood experiences,” Jane Ellen Stevens, founder/editor of ACEs Connection Network, Stevens writes,

Sumrok normalizes their addiction, which he explains is the coping behavior they adopted because they weren’t provided with a healthy alternative when they were young. He explains the science of adverse childhood experiences to them, and how their addictions are a normal – and a predictable – result of their childhood trauma. He explains what happens in the brain when they experience toxic stress, how their amygdala is their emotional fuse box. How the thinking part of their brain didn’t develop the way it should have. How it goes offline at the first sign of danger, even if they’re not connecting the trigger with the experience. Drugs like Zoloft don’t really help much, he tells them. Zoloft and other anti-depressants don’t remove the memory triggered by the odor of after shave that was worn by your uncle who sexually abused you when you were eight, or the memory triggered by a voice that sounds just like your mother who used to beat you with a belt, or by a face of a man  who looks like your father who used to scream at you about how worthless you were…the examples are infinite. 

To learn more about the ACE Study and ACEs and find an extensive list of resources, please visit Jane Steven’s post, “ACEs Science 101 (FAQs).”

And We Can Do This Now – We Can Treat Addiction the Same Way We’d Treat Other Chronic Diseases

But we must accept that this disease cannot be treated in 30 days any more than we’d dream it’s possible to treat cancer in 30 days. (Here’s the American Cancer Society’s treatment timeline for cancer for comparison.) It’s going to take time, but know that it is treatable!

The science is now available to explain what it’s going to take, but it’s recent so not widely known. In fact, most of the addiction-related scientific findings are within the recent 10-15 years. To help you zero in on this research explaining the science of the brain disease of addiction (aka substance use disorders), check out the Executive Summary of The U.S. Surgeon General’s Report on Alcohol, Drugs, and Health, NIDA’s Drugs, Brains, and Behaviors: the Science of Addiction, and the American Society of Addiction Medicine (ASAM)’s Definition of Addiction.

BUT…and this is a big, big BUT! How do you find good, effective treatment? It’s not like you can just take your loved one to or go to, yourself, the doctor to talk about your symptoms or to a hospital if you’re in critical condition the way you’d do if you had or suspected you had any other chronic disease. I will be writing a post on how to find effective treatment in a subsequent post, but for now, check out NIDA’s Principles of Effective Treatment and ASAM’s Treatment for Alcohol and Other Drug Addiction. For help finding a medical practitioner trained in addiction medicine, check out the American Board of Addiction Medicine, whose mission is to provide “assurance to the American public that addiction medicine physicians have the knowledge and skills to prevent, recognize, and treat addiction.”

 

What Can You Do to Help Spread This Message?

Get involved. If you are an organization, treatment center, behavioral health department, school, medical practice, community coalition — in other words, working to raise awareness, treat, fight, or prevent addiction — consider becoming a Partner of Facing Addiction’s Action Network. I’ve been a volunteer with this organization since its inception. This link, Who We Are – Facing Addiction, explains what Facing Addiction is all about. This link explains what being a partner with the Action Network means/involves. And if you decide to become a Partner, here’s the link to Join the Network – Facing Addiction.

If you are an individual struggling with addiction or a family member or close friend who loves someone who is, learn as much as you can about this disease and what it takes to treat it — the same way you’d delve deep and wide to figure out what it takes to treat heart disease, cancer or other chronic diseases.

And, as always, please feel free to call me 650-362-3026 or email me at lisaf@BreakingTheCycles.com. There is no charge for initial outreach calls.

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*NIDA (the National Institute on Drug Abuse) continues to use the term addiction and defines it as a chronic, relapsing brain disease. However, as NIDA also writes in the article just linked, “addiction” is not considered a specific diagnosis in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was updated in 2013. DSM-5 replaces the categories of substance abuse and substance dependence with a single category: substance use disorder. Given the general public still thinks of a person’s dependence on alcohol or other drugs as addiction, I used this term in this article.

©2017 Lisa Frederiksen

The Trauma of Children of Addicts and Alcoholics

The trauma that children of addicts and alcoholics experience can be life-changing. Frequent guest author, Darlene Lancer, JD, MFT, explains what it can be like her her article below. To read her longer version, please click Children of Alcoholics/Addicts. Darlene is the author of Codependency for Dummies and Conquering Shame and Codependency: 8 Steps to Freeing the True Youand her latest eBook is titled, Dealing with a Narcissist, 8 Steps to Raise Self-Esteem and Set Boundaries with Difficult PeopleShe can be reached at info@darlenelancer.com or you may wish to follow her on Facebook or visit her website www.whatiscodependency.com.

The Trauma of Children of Alcoholics by Darlene Lancer, JD, MFT

The Trauma of Children of Addicts and Alcoholics

Darlene Lancer, author of “Codependency for Dummies,” describes the trauma of children of alcoholics/addicts can experience.

Families with addiction are organized around the drinker or addict, and so is parenting. It’s unreliable, inconsistent, and unpredictable. There never is a sense of safety and consistency. Children are unable to thrive, and often suffer emotional, if not physical abuse. They carry issues of trust and anger about their past into adulthood. Sometimes, it’s directed at the sober parent, as well, who is often stressed, controlling, and irritable, while the addict may have withdrawn from family life. Family dynamics take a heavy psychological toll on children. Yet, more than half are in denial that they have an alcoholic parent.

Dysfunctional Parenting Causes Codependency

Living with an addict (including alcoholics[1]) can feel like life in a war zone. Parents are emotionally unavailable. Children’s needs and feelings get ignored. They may be too embarrassed to entertain friends and suffer from shame, guilt, and loneliness. Because an addict’s behavior is erratic and unpredictable, children live in continuous fear and learn to be on guard for signs of danger, creating constant anxiety that lingers long after leaving home.

Vulnerability and intimate relationships are considered risky, and children learn to contain and deny their emotions, which are generally shamed or denied by parents. In the extreme, they may become so detached that they’re numb to their feelings. They’re often hypervigilant and distrustful and many learn to become self-reliant and needless to avoid anyone having power over them again. The environment and these effects are how codependency is passed on – even by adult children of addicts who aren’t addicts themselves.

Family Roles

Children typically adopt one or more roles[2] that help relieve tension in the family:

The Hero

The Adjuster

The Placater

The Scapegoat

The Lost Child

The Mascot

Adult Children of Alcoholics and Addicts (ACAs)

Many children develop have undiagnosed depression (often low-grade, called dysthymia), anxiety, and trauma symptoms of PTSD – post-traumatic stress syndrome, with painful memories and flashbacks similar to a war veteran. Physical health may be impacted as well. The ACE (“Adverse Childhood Experiences”) study found a direct correlation between adult symptoms of negative health and childhood trauma. ACE incidents include divorce, various forms of abuse, neglect, and also living with an addict or substance abuse in the family. Children of addicts and alcoholics usually experience multiple ACEs.

Lisa Frederiksen, daughter of an alcoholic mom and founder of BreakingTheCycles.com, coined the term “Secondhand Drinking” (SHD) to refer to the negative impact a person’s drinking behaviors has on other people in the form of “toxic stress.” In her own recovery, she made the connection between ACEs and SHD and how toxic stress can result in generational addiction, including her own struggle with an eating disorder.

            “Both SHD and ACEs are two of the key risk factors for developing addiction (of which alcoholism is one). The two key risk factors are childhood trauma and social environment. Given SHD’s genetic connection, a person experiencing SHD-related ACEs then has three of the five key risk factors for developing the brain disease of addiction (alcoholism).”

Conversations with her mom helped Lisa forgive her and allowed her mom to forgive herself:

            “Mom and I talked about my realization that I’d blindly participated in passing along the consequences of my own untreated SHD-related ACEs to my daughters the same way my mom had blindly passed hers to me. And these consequences were not limited to developing alcoholism or an alcohol use disorder. They were the consequences of insecurity, anxiety, fear, anger, self-judgment, unclear boundaries, accommodating the unacceptable, constant worry, and the other physical, emotional and quality-of-life consequences of toxic stress. It was this shocking insight that moved me to treat my untreated SHD-related ACEs and help my daughters treat theirs.

            “Bottom line is these discoveries helped my mom finally forgive herself the way I had forgiven her years ago. Not the kind of forgiveness that excuses trauma-causing behaviors, rather the kind of forgiveness that lets go of wishing for a different outcome. It is the kind of forgiveness that recognizes we were all doing the best we could with what we knew at the time.”

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[1]In the recent DSM-5 manual for mental disorders, alcoholism is now referred to as an “Alcohol Use Disorder and alcoholics as a person with an Alcohol Use Disorder. Similar changes were made for other substance-related disorders, classified according to the substance, such as opioids, inhalants, sedatives, stimulants, hallucinogens, and cannabis.

[2] Adapted from Darlene Lancer, Codependency for Dummies, 2nd ed., Ch. 7, (John Wiley & Sons, Inc.: Hoboken, N.J. (2015)

 

©Darlene Lancer 2017

Joshua Butcher Sharing His Story of Addiction Recovery

Addiction Recovery –  there is a great deal of confusion, stigma, shame and discrimination surrounding addiction, addiction treatment and addiction recovery. Yet those who have the disease of addiction (whether to illegal or prescription drugs or alcohol) and are in recovery live healthy, productive, engaged lives — the same kinds of lives as people who do not have this disease. But all the words and definitions and explanations in the world are not as powerful as the people themselves. To that end, we are grateful to the people in recovery who have decided to share their experiences so that we all may put a Face to Addiction Recovery because it’s real, it happens to real people, and it happens all the time.

It is my great pleasure to introduce today’s Face of Recovery…

Joshua Butcher Sharing His Story of Addiction Recovery

Like most teenagers, I was curious to experiment with drugs and alcohol in high school – but I didn’t expect this curiosity to completely flip my world upside down for the worst. For me, getting drunk and high made me feel bigger than life itself – and I couldn’t help but always crave more of that high.

Joshua Butcher Sharing His Story of Addiction Recovery

Joshua Butcher sharing his story of addiction recovery.

I entered the world of substance experimentation at 15 when I had my first drink. After trying every liquor option, I moved onto drugs, such as smoking tobacco and marijuana. Marijuana, especially, was majorly abused when I was a teenager because it killed all my anxiety and completely wiped out my mind whenever I felt stressed or strangely alone in my thoughts. After a while, marijuana stopped satisfying me, and I went down the route of trying harder drugs to fuel depth of my highs: coke, ecstasy, and even a supply of Oxycontin made its way into my hands because I requested it under the prescription of a doctor to aid in some physical injuries I was recovering from. After I emptied the supply of medical opioids, I regularly bought heroin in the streets.

As you can see, I made one destructive choice after the other – and why? Well, I had nothing to lose, and there didn’t seem to be anything going for me. Therefore, I figured I might as well just stay in this “fun” phase until I was satisfied with it. But the truth was, I was never satisfied – I was addicted and spiraling without even realizing it. From 15 – 21, I was a heavy drinker, smoker, and abuser of every substance you can think of. I was arrested at least once every year, and I stopped caring about that too. Substance abuse frankly had some twisted sort of fun in the chaos of it all because getting high and drunk gave me a purpose – and that purpose was to simply survive another day.

It’s not that I was tormented with my life circumstances by any means, I just got caught up in the thrill-ride of drugs and craved substances like they were necessary for existence. If anything, I was just a kid who didn’t know any better, felt alone, got on the wrong path and consequently, followed it for too long. I was empty inside and needed to fill the void with something that felt substantial, and so I turned to alcohol and drugs.

Years of drinking and abuse blew up in my face once I found myself behind bars at 21, at the Franklin County Jail. I was found with pounds of heroin on my person and guilty of being under its influence while I was arrested. It’s the understatement of the year when I say being in jail was the worst 70 days of my life. Substance abuse can only numb you for so long until you’re dragged back to reality, kicking and screaming, and suddenly forced to confront every single thing you have done that made you end up at a breaking point.

After my 70-day sentence was up – by the grace of the universe – I was given a choice to either spend a decade of my life in prison or go into a rehabilitation program in Florida – and naturally, I chose Florida.

Initially, I thought I would hate rehab – but truthfully, I just hated myself for ending up there. But after a few days in the program, I knew I couldn’t always have an angry pity party for myself. Otherwise, I would go right back to my addictive habits. I needed to take a step forward into getting my life back. Eventually, I was able to break down so many walls about myself I wasn’t even aware of. I delved deep into my past and the sources of unhappiness that made me turn to drugs and alcohol in the first place. It made me question if I ever hated myself in the first place, or the quality of life I was living. Maybe, a part of me did hate myself because deep, deep down, I always thought I deserved better than what I was giving myself. I never had the motivation to do well in school, I acce’t stuck, I was just alone and unwilling to find what mattered to me.

Then, came the withdrawal period. You could not pay me all the money in the world to suffer it again. Detox was a painfully uncomfortable process. For months, I endured the physical pain of my body crying out for me to take drugs and drink again. I was constantly nauseous, my head would pound without mercy, and everything in my body felt cold and jittery. I was irritable and miserable every single day during that period, and nothing helped me except for accepting that I had to endure it to heal. I found it funny when I realized that your body is ironically not happy with you depriving it of substances. I had spent six years of my life dedicated to abusing them, and the consequences were not going to be kind to me – and neither did I expect them to be.

After I finished my rehabilitation program, I immediately decided that I wanted to open up a center dedicated to helping as many addicted individuals as possible. Addiction is a spiraling disease that drains people of life and happiness. Honestly, I thought if I could contribute something to this world and my town, it had to be giving the community my story and solutions. With them, I could steer others away from my path and devote my time to helping those who needed to recover and live their life again. This desire wasn’t established out of any obligation, I genuinely just felt so much empathy for those who shared my experiences that I wanted to take their pain away in any way that I could.

My experience in my past rehab program set the foundation for what the Ohio Addiction Recovery Center is today. Patients follow a long-term life-skill-based program that focuses on using community resources and utilizing personal skills to aid them in their journey of sobriety and most of all, encourage them to focus on better things and opportunities for the rest of their lives. We pride ourselves on the commitment and care we bring to our patients because we understand that rehab isn’t just a simple process of stopping drugs and moving on with life. It’s much more complicated than that, and it would be doing a disservice to look at it in such a basic manner. Everyone requires individual attention to get to the root cause of their addictions, confront the pains of their past, and take a step forward to a brighter future. Sobriety takes time, and recovering addicts need others to care about them and show that there truly is direction and purpose after addiction.

Addiction is an unfathomably dark place – but it isn’t an inescapable hole. One suffering addiction always has the ability and free will to tear themselves out of it and find the necessary tools to leave behind the past, cope with the present, and create a better future. People just have to be willing to find the light and wholeheartedly follow where it takes them.

 

When Your Child Struggles With Addiction | Author Linda Dahl’s New Novel Offers Help and Hope

When your child struggles with addiction, which is now understood to be a chronic, often relapsing brain disease, the world flips and turns in unimaginable ways. Days and nights become excruciating as a parent’s every attempt to help, stop, hold onto, and do anything and everything to save their child seems to slam into another wall, followed by periods of brief respites – perhaps even periods of recovery – and then slam – another wall. So it is always a huge help when a parent is able to speak out about their experiences – not that all parents should by any stretch of the imagination — but rather if they can. Because their experience(s) may just be just what another parent needs to hear in order to better handle the nightmare of their child’s addiction and learn what they can effectively do to help them.

When Your Child Struggles With Addiction | Author Linda Dahl's New Novel Offers Help and Hope

When your child struggles with addiction – Linda Dahl’s new novel, The Bad Dream Notebook, can help.

Today, I’m sharing a Q and A with Linda Dahl, author of The Bad Dream Notebook, her new novel detailing a family’s experience with a child’s addiction. She is the award-winning author of seven previous books of both fiction and non-fiction, including Loving Our Addicted Daughters Back to Life. Linda writes about challenging personalities and difficult issues, reflecting her interests in the arts and addiction and recovery. She has two children and lots of animals and lives in an old farmhouse in upstate New York, where she serves with several organizations that work to educate young people about and help them recover from drug use dependency.

For more about Linda Dahl, check out her website or follow her on Facebook.

Q: Tell me a bit about your latest novel, The Bad Dream Notebook.

A: It’s about several things that preoccupy and energize me. What can happen, good and bad, between a parent and child when the child becomes addicted. The healing power of compassion plus knowledge about the brain disorder of addiction. The creativity that is unleashed by facing fear and shame in all their hairy guises.

Q: What was the inspiration behind the book?

A: My family. There were four of us. Now there are three. My husband died of cancer just when my then-teenage daughter was becoming addicted to painkillers and then heroin. And although I am in longtime recovery, I missed the signs until it was –pardon the expression – smack in my face. I was as unprepared as any other parent to deal with a child’s addiction. Until I got educated about what helps and what hinders recovery, we both suffered every day. Now, one day at a time, each of us is clean and sober and thriving.

Q: Since it seems to be based largely on your life, why did you decide to write this book as a novel?

A: My previous book, Loving Our Addicted Daughters Back to Life, is a guidebook for parents and loved ones of young women struggling with addiction. It is the first book for a general audience about the wealth of scientific findings and evidence-based treatment that women need. That was inspired by our experience. Yet the story wouldn’t leave me alone. I felt that I’d written the intellectual fact-finding aspect of it, but the emotional, dramatic story was clamoring to be told.

Q: How did your communication approach with your daughter change over the course of her addiction?

A: The more I learned, the more I had to change the way we interacted. Although I knew from my own experience that shaming, begging, threatening etc., rarely if ever help a person suffering from this disease, that’s what I did with her. Active addiction is a minefield for all concerned. But as I got some clarity, I became much more matter-of-fact with her. I learned to avoid the diversionary tactics addicts use. I gave her choices, both carrot and stick. Bottom line, I asked myself if what I was doing was helping to keep her disease alive, or helping her move towards recovery. I became stricter and at the same time, more compassionate. And I never stopped telling her I loved her and hated her disease.

Q: I heard you had a somewhat serendipitous conversation with a banker that led to your daughter’s recovery. Can you tell me a bit about that?

A: So I’m one of those people who doesn’t believe in coincidences. I went to my bank to get a loan, because the fall-out from my daughter’s addiction had drained my resources, but I was determined to get her into a recovery center that worked – this time. I knew the man at the bank because he’d helped me deal with finances after my husband died. This time, as we sat on either side of his bank desk, I just opened up to him about why I needed the loan. And it turned out he had this amazing sister, a scientist and woman in recovery who’d designed a small recovery center in another state utilizing the latest gender-specific treatment that works for women. Within days, my daughter was on a plane. And it was excellent treatment with after-care at a well-run sober house. But still, she relapsed, oh I don’t know, several more times, before getting clean. Significantly, she later told me that small women-centered rehab was a turning-point, a place where she was encouraged to open up about her trauma and shame, two things that bedevil female addicts particularly. It was extremely important for her to find a way to trust and respect herself.

Q: What do you think was the turning point for your daughter? The point where she knew it was finally time for her to help herself.

A: She finally put together about eight months of recovery in another state. She had a wonderful sponsor. But she was also in a relationship. So she and the boyfriend came to visit me for a week. And she went out and scored some heroin. We found out. The boyfriend and I laid down our bottom lines – either you get rid of the dope and immediately get to a meeting and get a temporary sponsor, or he’s leaving and you will have to find another place to stay. And it worked. She was between that rock and hard place where I believe you have to get to. Where you’re finally willing. I saw tremendous change in her after that.

When Your Child Struggles With Addiction | Author Linda Dahl's New Novel Offers Help and Hope

Check out Linda Dahl’s new novel

Q: What message(s) do you want readers to take away from The Bad Dream Notebook?

A: I want people going through what I did – and there are millions of us – to stop being so hard on themselves. Addiction is not the result of bad parents or a moral failing or a lack of willpower. When we read the science, we get that it’s a brain disorder which robs the sufferer of the ability to make rational decisions. And we have to learn that love without understanding how the disease operates is not enough. Compassion plus comprehension are vital in turning it around.

And one more thing, which may sound surprising. People who come to a 12 step meeting for the first time often say they’re amazed at all the laughter. So it is in The Bad Dream Notebook. Because laughing at life is one of the best antidotes to suffering I know.

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Excessive alcohol use, either in the form of binge drinking or heavy drinking, was responsible for an average of 88,000 deaths annually in the United States from 2006 – 2010. (Source: CDC>Excessive Drinking, accessed 8/11/17) This is equal to 241 deaths per day.

In view of these statistics, which I find staggering, as is the fact they’re not widely known by the general public, I offer the following suggestions to answer the question, “What can WE do to stop this?” Because it’s going to take the “WE.”

Understand Excessive Alcohol Use

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Excessive alcohol use is considered binge drinking or heavy drinking.

“I only had a couple of drinks,” or “We each had a drink and then split a bottle of wine.” These kinds of statements are common when someone gets into trouble as a result of how much they’ve had to drink. Sometimes the speaker is absolutely baffled at being pulled over for a DUI or having a hangover in the morning because they are sure they’d only had a few.

So understanding what’s considered “low-risk” drinking can help a person avoid excessive alcohol use.

According to the NIAAA>RethinkingDrinking website,

  • women should not exceed 7 standard drinks/week, with no more than 3 of the 7 on any day
  • men should not exceed 14 standard drinks/week, with no more than 4 of the 14 on any day.

These limits are to help a person avoid the excessive drinking (binge drinking/heavy drinking) that lead to the 88,000 deaths per year in the U.S. reported in my opening statement. Binge drinking is defined as drinking 5 or more standard drinks on an occasion for men or 4 or more standard drinks on an occasion for women. Heavy drinking is defined as drinking 15 or more standard drinks per week for men or 8 or more drinks per week for women.  Most people who drink excessively are not alcoholics or alcohol dependent. (Source: CDC>Fact Sheets – Alcohol Use and Your Health, accessed 8/11/17) In fact, according to the CDC, more than half of these 88,000 deaths were due to binge drinking. (Source: CDC>Excessive Drinking, accessed 8/11/17)

As for “standard drinks,” in the U.S. a “standard” drink is any drink that contains about 0.6 fluid ounces or 14 grams of “pure” alcohol. And it’s the “pure” alcohol that’s the concern as it contains the ethyl alcohol chemicals that interrupt the brain’s cell-to-cell communication, and it’s this cell-to-cell communication that controls everything a person thinks, feels, says and does. Some common standard drink sizes are 5 ounces of table wine, 12 ounces of regular beer, 8-9 ounces of the IPA kinds of beer, 1.5 ounces of “hard” liquor (vodka, scotch, bourbon, tequila).

Often common drinks or beverage containers people serve and/or consume at parties or restaurants contain more than one standard drink as listed below. Not understanding this can cause a person to drink more than they’d planned.

  • a margarita = 2-3 standard drinks
  • a martini = 1.5-2 standard drinks
  • a “stiff” scotch on the rocks = 2-3 standard drinks
  • a bottle of table wine = 5 standard drinks.

To find out how many standard drinks there are in your favorite cocktail, click here, and in your favorite alcohol beverage container, click here.

Understand How the Body Processes Alcohol

Why is this so important to understand? Because alcohol (the ethyl alcohol chemicals in alcoholic drinks) is not processed like other foods and liquids. It is metabolized (processed) by enzymes in the liver. It takes the liver about one hour (often up to two depending on other variables, such as weight, gender, having eaten, stage of brain development or medications) to metabolize the ethyl alcohol in one standard drink.  So if a person consumes 3-4 drinks, it’ll be roughly 3-4 hours before their body is clear of all alcohol. While alcohol waits its turn to be processed by the liver, it is “sitting” in body organs, like the brain. It’s this sitting in the brain that changes how a person thinks and behaves because the ethyl alcohol chemicals in the alcohol beverages consumed interrupt neural networks and therefore normal brain functioning.

Assess Your Drinking Pattern

NIAAA Rethinking Drinking’s website has an anonymous, online, 2-question drinking pattern assessment that can be found here. Another assessment is the AUDIT (Alcohol Use Disorders Test) by the World Heath Organization.

Know that Alcohol Works Differently in the Teen Brain

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

Alcohol (and other drugs) works differently in the young brain that it does in the adult brain due to key brain developmental processes occurring age 12-25.

Little did we know until the Decade of the Brain (1990s) and the Decade of Discovery (2000s) that the brain could take until the average age of 24 for boys and 22 for girls to fully develop. Little did we know that the kinds of brain developmental activities that occur from ages 12 – early 20s, often through 25, explain why teens do the things they do (seek risks, not consider potentially negative outcomes, for example) and why excessive drinking can be so problematic for young people’s brains.

In my fourteen+ years of studying brain research and writing on brain development and the brain disease of addiction, understanding the whole story about puberty and the brain’s evolution [see Image 2 in article linked below] gave me the pieces that finally completed the puzzle on how/why teens do the things they do and how/why their peers are so influential and why all of this is so instrumental in the development of a more serious drinking problem.

To explain why it’s so important we understand puberty and what it does in the brain, check out my posts, Want to Get Through to Teens, Talk to Their Brainsand Give Their Brains a Break – Underage Drinking Prevention.

And by the way, the Europeans don’t have this whole underage drinking issue figured out, either. In fact it’s a huge problem there, as well. So check out the 2015 European School Survey Project on Alcohol and Other Drugs.

And one more point, here, treating an adolescent with alcoholism is not the same as treating an adult – primarily because of the developmental processes the adolescent brain goes through. For more on this, check out NIDA’s Evidence-Based Approaches to Treating Adolescent Substance Use Disorders.

Understand that People Develop Alcoholism (aka Alcohol Use Disorders)

Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?

A person develops the brain disease of alcoholism. Find out how and why – click here to order

Thanks to all of this brain research, it’s now understood that addiction (of which alcoholism or alcohol use disorder is one) is a developmental, chronic, relapsing brain disease. People are not born alcoholics, nor do they choose to become one. They develop it and often that’s because of the myths, stigma, misinformation and shame that surrounds the disease of alcoholism. To debunk these myths, please check out my eBook, Crossing The Line From Alcohol Use to Abuse to Dependence.

And for more on how alcohol works in the brain and what makes addiction (alcoholism) a brain disease, check out NIDA’s Drugs, Brains and Behaviors: The Science of AddictionYou might also want to check out The Surgeon General’s Report on Alcohol, Drugs and Health (released 2016).

Lastly, I’d shared what NIDA recommends for treating adolescent addiction (alcoholism) above, here’s the link to NIDA’s>Principles of Drug [alcohol is considered a drug] Addiction Treatment: a Research-Based Guide for treating adults.

Understand Secondhand Drinking

One last thing for now… it’s important to understand the very real impact of a Excessive Alcohol Use Kills 88,000 Americans Annually | What Can WE Do to Stop This?person’s drinking behaviors on others – especially family members and close friends. And that is secondhand drinking, which affects 90 million Americans. These impacts are related to stress – the stress a person dealing with a loved one’s drinking behaviors experiences. These stress related impacts can include: depression, anxiety, stomach ailments, cardiovascular problems, sleep disorders, muscle aches, skin problems and so much more. To learn more, check out my eBook, Secondhand Drinking: The Phenomenon That Affects Millions

You might also want to check out my article, What to Say to Someone With a Drinking Problem.

For more information…

Awareness is half the battle, and there are many resources to help reduce excessive alcohol use, so if you have a question or wonder about what I’ve written here, please feel free to call me at 650-362-3026 or email me at lisaf@BreakingTheCycles.com. I’m happy to talk with you or help you find the answers you need.

©2017 Lisa Frederiksen