Chronic Pain and Opioid Addiction

Chronic Pain and Opioid Addiction - understanding pain is in the brain and why can help.

Chronic Pain and Opioid Addiction – understanding that pain is in the brain and why can help.

Many people can’t understand how someone becomes physically dependent or develops an addiction to an opioid pain medication, such as Vicodin, Dilaudid, OxyContin, Duragesic and Norco, prescribed by their doctor. Understanding the following key concepts can help:

  • The brain controls everything we think, feel, say and do through neural networks and brain maps.
  • Pain is in the brain.
  • Pain meds don’t just block opioid receptors – they also trigger massive releases of dopamine neurotransmitters.
  • A person can be physically dependent and not addicted to a pain med, yet the withdrawal symptoms can be the same.

Neural Networks, Brain Maps and Pain

The nervous system is made up the brain, spinal cord (these two together are referred to as the Central Nervous System) and Peripheral Nervous System.

The nervous system is made up the brain, spinal cord (these two together are called the central nervous system) and peripheral nervous system.

Neural networks are the way brain cells (neurons) talk to one another. They, in turn, exchange information with other neurons (cells) throughout the body via the nervous system.

This “talking” is done through an electro-chemical signaling process. This is easier to understand if you think of neural networks as strands of holiday lights. Anything that happens along a strand of holiday lights – a loose bulb, frayed wire, power surge – changes how that strand works. This in turn changes how all other strands connected to it work.

Basics of a Neural Network
The following is a simplified description of what goes into making a neural network. If any one of these “things” is changed or different, it changes the way neural networks perform, which can then cause a person to think, feel and behave differently. This is where the strand of holiday lights example comes in…

  • Cue or Trigger – a sound, sight, touch, smell, memory, emotion…something that triggers the electrical portion of the electro-chemical signaling to start.
  • Brain cells (aka neurons) – the “brains” of the neural network; messages are passed from one to another.
  • Axons and Dendrites – outgoing and incoming branchlike extensions – take messages to and from cells.
  • Neurotransmitters – the chemical part of the electro-chemical signaling process located at the end of outgoing branchlike extensions. These change the electrical signal into a chemical signal that can float across the synapse.
  • Synapse – the gap between outgoing and incoming branchlike extensions at the ends of brain cells.
  • Receptors – located at the end of incoming branchlike extensions. They accept the neurotransmitter – like a “key in a door lock” – and change it back into an electrical signal to carry on the message to the receiving cell.

Pain and opioid pain medications work on all of these “things” on a wide-ranging, SIGNIFICANT number of neural networks.

Brain Maps for the Things We Do
Through a series of connections, neural networks form systems between the brain and other organs to control our body’s major functions. These include the fight-or-flight stress response system, for example, as well as the circulatory and digestive systems.

Neural networks also work together to form “brain maps” for the things we do regularly. Brain maps take very little, if any, thought. They just happen. And thank goodness they do. If we did not have these brain maps, we would still be trying to get out of bed because the millions of neuron connections needed to do that simple function would take forever to hook together. So, over the course of our lives, we create brain maps for riding a bike, typing, brushing our teeth, reading, climbing, swimming, driving a car, operating equipment, playing an instrument, texting—just think about it! Basically, then, brain maps are our habits, coping skills, life skills and typical behaviors.

When we map opioid pain meds as the answer to relieving our pain, however, the pain meds CAN become the brain’s “coping skill” long after the injury site is healed.

Sharing all of the above and this next section is intended to help a person understand what they can do to change, re-wire (re-map) their brain.

How the Brain Maps Chronic Pain

When you injure yourself, pain receptors in the peripheral nervous system send pain signals to the spinal cord. At the spinal cord, bundles of sensory neurons in the dorsal horn act as a hub and send reflex messages to the injury site (take your hand off the burner, for example) and pain messages to the brain. These pain messages to the brain run throughout, triggering neural networks ranging from those involved with fight-or-flight, to those responsible to assessing this pain in context of similar pain, to so many more too numerous to count.

And this is where it can get “complicated.” If the brain attaches fear to the event – say fear about what you’ll be able to do now that you’ve broken your foot, or it attaches anxiety to the injury event – say anxiety about doing something, like exercise, that might make the pain worse, or it attaches worry about the prognosis for a full recovery, the brain starts to get the pain messages linked up with the emotions. So that if a person feels that twinge of fear when they move their foot, the brain “reads” it as pain. Additionally, if the brain is under major emotional stress around other things going on at the time of injury, say loss of a job, it can attach those stress-related feelings to the feeling of pain, as well. Thus when another job application they’ve submitted is declined, for example, their brain “feels” that old “pain.”

Not only this but pain often interrupts sleep and gets in the way of wanting to exercise. Both lack of sleep and lack of exercise in turn change brain chemistry, which in turn can lead to depression or a brain mapping that further inhibits sleep and exercise. And why would this be such a problem? When the brain does not get the powerful brain benefits of restful sleep and exercise (these actually “do things” to various parts of those strands of holiday lights), it interrupts normal neural network activity, which then exacerbates the problem.

Not only are there all of these sorts of emotion / thought-related mappings going on, BUT there are the brain maps around the chemical interruptions to the neurotransmitters and receptors’ portions of various neural networks. These interruptions are caused by the chemicals in the drug compound, itself.

How Opioid Pain Meds Work in the Brain | Body

A portion of the pain med compound binds to receptors at the injury site. A portion of the pain med compound binds to opioid receptors found throughout the brain and nervous system – the receptors on neural networks involved with the “complicated” bit above. And a portion trigger massive releases of dopamine neurotransmitters – the neurotransmitters responsible for the brain’s pleasure/reward neural networks.

With the surge of dopamine component of an opioid pain medication, the pain is not being “killed,” per se – rather it’s being overwhelmed by the content, euphoric, satisfied feelings that dopamine neural networks provide. And, of course, the brain likes that feeling, so it maps the desire for pleasure (which comes with the pain meds), in addition to all of the other brain mapping going on.

This is where the strand of holiday lights analogy comes into play, again. Between the “complicated” stuff described above and the brain / body pain med interactions, there are so many strands (neural networks) with frayed wires, loose bulbs and power surges, that a person’s thoughts and behaviors and what they feel and how they react / respond is out of wack.

Acute vs Chronic Pain

In the case of acute pain, which is normal, and lasts anywhere from a week or two to a few months, pain medications help calm all of the opioid reliant neural networks involved with injury pain. Once the injury site is healed, the brain no longer feels pain and the person is weened off their pain medication.

BUT, in the case of chronic pain, the continued feeling of pain MAY be being triggered by the “complicated”-related brain mapping around fear, anxiety, emotions related to other events going on at the time and the “ah” feeling mapped around dopamine described above. The brain can actually be hijacked, if you will, because it has maps that “tell it” that pain meds are the answer to “pain” – pain which is now triggered by emotions, memories and the drive to feel good – all of the cues it has mapped to be “answered” by the pain med. The brain goes after the meds with cravings for the medication that can be 3-5 times stronger than the instinctual drive to eat food when hungry. In this manner, loss of control - the ability to “just stop” or to cut back – is another problem as the brain sets up the desperate seeking and using of the drug that it mapped as making it all feel better; yet the original dosageno longer works because of the chemical and physiological imbalances caused by abuse of the pain medications. Additionally, the chemical imbalances that occur as neurotransmitters are depleted and receptors become less sensitive set up tolerance - meaning a person can consume quantities that are far greater than what a “normal” person could handle. When these characteristics (cravings, loss of control, tolerance and physical dependence, explained next, are present, it’s likely the person has developed addiction, a chronic, often relapsing brain disease.

[Strong disclaimer #1: this is NOT to suggest that all pain is related to this “complicated” description. Arthritis and cancer, for example, cause very real chronic pain for which opioid pain medications are the “answer.” Strong disclaimer #2: there are a host of reasons that have nothing to do with pain that can cause a person to develop an opioid addiction.]

As for what to do, see the last section of this post.

Opioid Pain Medication Withdrawal Symptoms

Withdrawal symptoms are the result of the body’s physical dependence on the pain medication. This is because it takes time for the liver to metabolize the chemicals in opioid pain meds, so while it’s “waiting” to metabolize, it is sitting in lots of body organs that are highly vascularized (meaning lots of blood vessels) – not just the brain. In this manner, these other organs demand the pain meds to avoid the awfulness of withdrawal symptoms described in the following excerpt from Opiods911.org/safety:

“Opioid withdrawal is not harmful or life threatening, but it can be very unpleasant and even painful. Going through opioid withdrawal is somewhat like having a bad case of the flu. It can take 6 hours or much longer after reducing or stopping an opioid medicine, or starting a new medicine or product that interacts with the opioid, before withdrawal starts. The amount of discomfort, and how long it lasts, depends on the type of opioid medicine that was taken, how long it was used, and the dose.??Here is what to watch for…

Screen Shot 2014-08-28 at 7.45.40 AM
“It is important to understand that tolerance and withdrawal are not signs of addiction in a person who is taking opioid medicine correctly, as prescribed for pain. If your medicine seems to become less effective in relieving pain, or you experience opioid withdrawal at any time, even mild discomfort, contact your opioid prescriber. Never take extra opioid medicine on your own.” Source: http://www.opiods911.org/safety.php

What to Do

  • Talk to your doctor, and if you are not satisfied with their response, seek another opinion.
  • Understand addiction. The National Institute on Drug Abuse (NIDA) has an excellent explanation, “Drugs, Brains and Behaviors: the Science of Addiction,” and The Addiction Project, a collaboration of the NIDA, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Robert Wood Johnson Foundation and HBO.
  • If it is the “complicated” stuff described above and the person actually has developed addiction, it will take “re-wiring” neural networks, which first requires removing the pain medications and then getting appropriate treatment. NIDA has written an excellent guide, “Principles of Effective Treatment: a Research-Based Guide (Third Edition),” that can help.
  • If it’s not the “complicated” stuff, work with your doctor on what to do to ween you off the medication and/or prescribe another that won’t have the same withdrawal or side effects as what you are currently experiencing.
  • Check out FAQs answered by OpioidSafety911, as well as their section, titled: “How can I prevent problems with opioids.”
  • Take the time to watch this excellent, less than 5-minute video on chronic pain and what to do about it.

 

©2014 Lisa Frederiksen. All Rights Reserved. Much of the above are excerpts from two eBooks that will be published as part of my upcoming Quick Guides collection.

Harm Reduction – Can It Work?

There are various takes on harm reduction – both on what it means and on what success looks like.

For the purposes of this post, I am referring to harm reduction in terms of changing one’s drinking pattern and/or stopping drinking all together before they develop the chronic, often relapsing brain disease of addiction (in this case, an addiction to alcohol).

When Should a Person Consider Harm Reduction

The short answer, “When their drinking causes drinking behaviors.” Drinking behaviors are what a person does when the amount of alcohol they have consumed changes the way their brain works.

This change in brain functioning is because of the way the body processes alcohol. It takes about one hour for enzymes in the liver to metabolize the ethyl alcohol (chemical) in one standard drink. Thus, if a person drinks four drinks, it will take four hours for the alcohol to be fully metabolized. This means that until the ethyl alcohol is metabolized, the chemical is interrupting the chemical portion of the brain’s electrical-chemical signaling. The latter refers to the brain’s neural networks, aka neural transmissions; basically the way cells in the brain talk to one another and to and from those in the rest of the body via the nervous system. It is this electrical-chemical, cell-to-cell “talking” that controls everything a person thinks, feels, says and does.

Thus, alcohol “sitting” in the brain (and other body organs) waiting for its turn out the liver changes the chemical portion of normal neural transmissions and thus changes a person’s behaviors, causing drinking behaviors. These include: verbal, physical and emotional abuse; illogical, insane-making circular arguments; physical assault; driving while impaired; unplanned or unwanted sex and blackouts, to name a few.

And it is the drinking behaviors that cause secondhand drinking (SHD) impacts for the people on the receiving end. These SHD impacts include:

  • Deeply hurt feelings, losing one’s self-esteem, walking on eggshells.
  • Having to deal with the fall-out of someone driving while impaired, whether that is death or injury or ticketed DUI, for example.
  • Recovering from a broken arm after a brutal beating or from a sexual assault.
  • Developing depression or anxiety, feelings of hopelessness or helplessness.
  • Taking medications for stomach ailments or sleep disorders.
  • Unable to concentrate at work or in school.
  • Losing friends, dreading social events, trying to keep track of a constant stream of white lies and cover-ups.

Assess Your Drinking Pattern

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a Single Question Screen to assess “at-risk” drinking:

  • How many times in the past year have you had 4 or more standard drinks in a day? (for women)
  • How many times in a day have you had 5 or more standard drinks in a day? (for men)
  • A standard drink is defined as: 5 ounces of wine, 12 ounces of regular beer, 1.5 ounces of 80-proof hard liquor, 8-9 ounces of lager beers/ale and 3.3 ounces of champagne. Often drinks served in bars and restaurants or at social events contain more than one standard drink.

An answer of once or more is considered “at-risk” drinking.

Common “at-risk” drinking patterns include:

  • Binge Drinking – defined as having 4 or more standard drinks on an occasion for women and 5 or more for men.
  • Heavy Social Drinking – defined as routinely having more than 1 standard drink a day for women or 2 standard drinks a day for men.
  • Alcohol Abuse – defined as regular binge drinking and/or heavy social drinking.

By comparison, “low-risk” or “normal” drinking is defined as:

  • For women: No more than 7 standard drinks in a week, with no more than 3 of those 7 in any one day.
  • For men: No more than 14 standard drinks in a week, with no more than 4 of those 14 in any one day.

Harm Reduction – Can it Work?

One of the reasons a person loses control of their drinking and another person tolerates drinking behaviors (secondhand drinking) is the assumption that drinking is either “normal” or “alcoholic.” Determined “not to be an alcoholic,” an individual may continue their harmful drinking patterns and their loved ones continue to tolerate their drinking behaviors, simply because they don’t understand there are actually three stages of drinking: use, abuse and dependence.

3-stagesofdrinking.HarmReduction

 

To the question, “Can harm reduction work?” Yes, it can – meaning a person can reduce their drinking to fall within “low-risk” limits – IF they are NOT an alcoholic. If they are, it is imperative they stop all alcohol use entirely. Additionally, for some people, harm reduction means stopping drinking all together just because they don’t want to continue drinking given the way it leaves them feeling about their behaviors or their health.

To further assess your drinking pattern and find tips for cutting down – aka harm reduction – visit NIAAA’s Rethinking Drinking website for more information.

Bottom Line

Societally and individually, we would not tolerate drinking behaviors if a person were sober, yet for some reason, we excuse them “because they were drunk” or “they’d been drinking.” And it is in that excusing that we harm our own safety, health and well-being if we are the one coping with secondhand drinking, and if we are the person whose drinking is causing drinking behaviors, we not only harm those we love the most, we potentially cross the line from alcohol abuse to dependence.

So, if you see your drinking pattern in this post, give harm reduction a try. There is every reason in the world to reduce your drinking pattern to fall within “low-risk” limits – for yourself and for those you love.

For more information, please consider my short eBook, Crossing The Line From Alcohol Use to Abuse to Dependence

Talking to Children About a Parent’s Recovery

Talking to children about a parent’s recovery – yes? no? sort of? But how?

Your spouse is about two-thirds the way through a 28-day rehab. You see great progress, but s/he still doesn’t want to tell the children. S/he says your younger ones are too young to understand and the older ones are so engrossed in their own issues, they don’t need the added burden. But you’re not so sure it’s a good idea not to say something.

And, you are right.

In fact, it’s imperative for your children’s sake that you do. Your children know something is going on, just as they knew something was going on during the years of your loved one’s active addiction. The concern is what do your children think and feel? what conclusions have they drawn? do they feel responsible somehow? are they afraid it won’t last – whatever it is? do they wonder if there’s something they should be doing for their parents to make things better?

Children living in families with addiction and addiction recovery have so many, many questions. But it’s not the questions that are as worrisome as it is the conclusions they’ve drawn in the absence of their parents talking to them – sharing the facts of what’s going on to the best of their abilities and then inviting them to share their thoughts and feelings.

To explain why it is so important is to talk with children is to share a bit about the key developmental processes a child’s brain goes through from birth through 25ish. [Just a heads up - this post is a bit long.]  It is during these developmental processes that a child’s brain circuitry (cell-to-cell communication) wires and rewires and it is that wiring and re-wiring that determines everything your child thinks, feels, says and does. Unfortunately, the wiring in a younger child’s brain can’t grasp the complexity of long addiction explanations and the wiring in a middle school child’s brain is not all that much better. See Image 2 below. Nonetheless, it’s important you start the conversations – keep them simple, engage in new ones often – and know there’s no one-nor-right way to do it. Most of all – know that it absolutely matters that you do.

Understanding Child Brain Development Helps With Talking to Children About a Parent’s Recovery

The following is an excerpt from my upcoming eBook, Secondhand Drinking: the Phenomenon That Affects Millions.

At Birth
We are born with about 100 billion brain cells (neurons), but only a small number of them are “wired” at birth (meaning one cell talking to another cell throughout the brain and body via the nervous system). This makes sense when you think about it. If all of our neural networks were wired at birth, we would come out doing what we do as adults. But about all a baby’s neural networks do is allow it to breathe, eat, sleep, cry, smile and dirty their diapers.

First Decade
In the first decade of life, the brain wires trillions of neural networks. This is why childhood trauma (verbal, physical or emotional abuse, neglect, bullying, Secondhand Drinking-related stress), mental illness (anxiety, depression, ADHD) and social environment have such a big influence on the developing brain and a child’s behaviors. Genetics is another big influence. So are a child’s own thoughts and behaviors and lack of cerebral cortex wiring (explained shortly). This means that everything that was going on in your child’s family life around the addiction, addiction recovery and secondhand drinking was influencing your child’s brain wiring.

It also means the cell-to-cell communications (neural networks), aka your child’s brain wiring, that was repeatedly firing at the same time, likely formed brain maps around the activity, reaction, behavior or thought. What?? you might be saying. Take the brain map around riding a bike. All the neural networks that were repeatedly activated to master that activity formed a brain map around the activity. It’s why an adult can get on a bike and ride it even if it’s been 10 years since the last time. We form brain maps for just about everything we do repeatedly: text, type, swim, read, eat, brush our teeth, drive…. This is so the brain doesn’t have to think through each tiny step of everything you think, feel, say and do – if it did, you’d still be getting out of bed. Thank goodness we can change our brain maps, too, but that’s another post.

Then Comes Puberty Around Age 12
Puberty is an instinctual wiring process (meaning it is built into the human species). It causes lots of neural network wiring activity–especially in the limbic system (the reactionary, not thinking, part of the brain). The purpose of puberty-related brain wiring is to cause the species to turn to its peers and take risks. It is also to take care of the obvious–-adult-like bodies capable of reproducing. These three instinctual drives (take risks, turn to peers and reproduce) were critical to the survival of the human species back in the day when mankind had a simpler, shorter lifespan and parents were likely dead, unable to protect a child from around age 12 on. During this stage, there are a whole lot of new feelings influencing your child’s “thinking,” something they’re lacking because the third stage has yet to begin.

And Finally, the “Thinking” Part of the Brain

Science groups neural network activity into three main areas in the brain - as shown in the image above. The one of particular interest in discussions about Secondhand Drinking and Drinking Behaviors is the Limbic System.

Image 1: Science groups neural network activity into three main areas in the brain – as shown in the image above. The cerebral cortex (the thinking part of the brain) does not start developing until around 16 and takes on average until age 22 for girls and 24 for boys.

Today, however, these instinctual drives can be a bit of a problem because we live much longer, more complex lives. Here’s why. There is about a four-year lag time between the start of puberty around age 12 and the start of the last stage of brain development—wiring in the cerebral cortex (see Image 2 below).

As described in Image 1 to the right, the cerebral cortex is responsible for sound reasoning, good judgment and weighing the consequences of one’s actions. It is also the brakes on the risk taking behaviors that start with puberty. And it is when the brain starts to “prune” neural networks not used much and “strengthen” those that are. This pruning and strengthening process is designed to make the brain more efficient.

As stated, back in the day life decisions were pretty simple, mostly focused on survival – finding food, staying safe and reproducing. Today, our lives are far more complicated and much longer. This means the consequences of the mistakes we make and the brain mapping we set into place as teens can last for a very long lifetime (unless we take steps to correct or fix them, of course).

Why Ages 16-25 Matter So Much
While wiring in the cerebral cortex starts around age 16, it takes until around age 22 for girls and age 24 for boys to complete. The darker colors in Image 2 below show us just how much brain development is happening. I think NIDA’s addition of the school pictures further drives home the point that the brain at 5 is incapable of understanding that which is possible with an 18 year old brain.

Child's brain goes through critical developmental processes aged 5-20 and continues until around 22 for girls and 24 for boys. Source: NIDA, "Cormorbidity: Addiction and Other Mental Illnesses," p. 4

Image 2: A child’s brain goes through critical developmental processes aged 5-20 and continues until around 22 for girls and 24 for boys. Source: NIDA, “Cormorbidity: Addiction and Other Mental Illnesses,” p. 4

This lag time between the start of puberty and the start of the cerebral cortex wiring helps explain why teens make poor “decisions” – including judgements about what they think is going on with a parent’s addiction and recovery.  It also helps us understand that the neural networks strengthened during this period of brain development typically become our brain maps for many of our adult-like habits, coping skills, life skills and behaviors.

Another analogy that can help illustrate how much the “thinking” part of the brain changes from 12-16 and then on through age 22 for girls and 24 for boys, is to think about the 12 year old brain. Because, yes, children have been thinking and reasoning for a long time – heck, some are even taking AP classes in school. But the kind of wiring I’m talking about at this stage is different – it has to do with adult-like reasoning, thinking skills.

Would we even imagine giving the car keys to our 12 year old and telling them to go practice driving on the freeway so that they’re good and ready by the time they take their driver’s test at 16? We know their brains are incapable of handling 4 lanes of whizzing cars cutting in and out, giant big-rigs pulling onto the freeway, motorcycles coming up the middle between lanes, let alone distracted drivers doing dumb things, like looking down to text instead of ahead at the looming red taillights of the car in front in time to stop. That’s what it means to be able to “think,” to engage in the complex “reasoning” skills that make that sort of driving possible – capabilities that don’t even start to wire until around age 16.

As you can see, at each stage of brain development there are different capabilities to grasp what you are telling them, and on the flip side of this, there are different capabilities to interpret what’s going on in the absence of someone they trust giving them the truth and facts of the matter.

Understanding this may help you in your conversations and bolster your confidence in the need to talk with them – whatever their age.

Talking to Younger Children

As you can see from the school pictures in Image 2, that’s who you’re talking to – a very young mind with very limited, adult-like reasoning capabilities.  With this age group, messages along the lines of the following can be useful:

As you know, things have been kind of crazy - sometimes scary – around here. And you also know that Daddy/Mommy has been gone. It’s because we now understand part of what was wrong – why Mommy/Daddy changed so much when s/he drank. And now that we understand this, Mommy/Daddy is getting help, and I am learning more about what all has happened so I can better explain it to you. The best news, though, is Mommy/Daddy can get better. Just know we both love you very much. 

OR

As you know, things have been kind of crazy - sometimes scary – around here. We are just figuring out why, but we have really good doctors and counselors helping us and believe things are going to turn out fine. It’ll take a while, but things will be OK. Just know that Mommy and Daddy love you so much and are doing everything we can to make things better. If you ever want to talk about it, I’ll do my best to answer your questions or find a person who can.

Talking About a Parent’s Recovery to Older Children

Again, looking at the school photos in Image 2, it’ll depend on their age to determine how much they’ll be able to fully grasp a more complicated explanation. Generally, older children want more detail – though not of the overwhelming kind. But they do want specifics. This is where using two excellent resources to explain addiction and recovery can be helpful: The Addiction Project (a collaborative effort of NIDA, NIDAA, the Robert Wood Johnson Foundation and HBO) and NIDA’s Drugs, Brains, and Behaviors: the Science of Addiction.

Claudia Black, Ph.D., has an excellent book that can help with this AND it can help with how you’ll talk to your children about their own drug or alcohol use given their parent(s) did it, too: Straight Talk from Claudia Black: What Recovery Parents Should Tell Their Kids about Drugs and Alcohol

David Stack, M.D., has an excellent article on Huffington Post, “How to Talk to a Child About a Parent’s Addiction.” Though his is focused on the disease, understanding the disease helps with understanding Recovery and many of the conversation tips apply to both.

Bottom Line

Talk about it. You will be giving them a huge gift if they can hear it from you and know that they have you to help them understand and weather what’s next. Recovery can be an exhilarating time. It can also be a scary time as all start to figure out what life is like without the disease. Speaking of which, it’s important the parent who does not have addiction also get help, because secondhand drinking | secondhand drugging, the impacts of a person’s drinking | drugging behaviors on others, has taken its toll on them, as well.

As always – feel free to call 650-362-3026 with questions or email me at lisaf@BreakingTheCycles.com.

©Lisa Frederiksen 2014

How to Spot Manipulation – Darlene Lancer

How to spot manipulation can be a key to one’s recovery from the affects of growing up or living with untreated alcoholism or addiction. Author of Codependency for Dummies and Conquering Shame and Codependency: 8 Steps to Freeing the True YouDarlene Lancer explains how to spot manipulation in today’s guest post…always a pleasure to share Darlene’s work!

How to Spot Manipulation by Darlene Lancer
DarleneLancer.manipulation

Manipulation is a way to covertly influence someone with indirect, deceptive, or abusive tactics. It may be hard to detect and seem benign or even friendly or flattering, as if the person has your highest concern in mind, but in reality it’s to achieve an ulterior motive. Addicts routinely deny, lie, and manipulate to protect their addiction. Their partners also manipulate for example, by hiding or diluting an addict’s drugs or alcohol or through other covert behavior. They may also lie or tell half-truths to avoid confrontations or control the addict’s behavior. Some manipulation is veiled hostility, and when abusive methods are used, the objective is merely power. You may not realize that you’re being unconsciously intimidated.

If you grew up being manipulated, it’s harder to discern what’s going on, because it feels familiar. You might have a gut feeling of discomfort or anger, but on the surface the manipulator may use words that are pleasant, ingratiating, reasonable, or that play on your guilt or sympathy, so you override your instincts and don’t know what to say. Codependents have trouble being direct and assertive and may use manipulation to get their way. They’re also easy prey for being manipulated by narcissists, borderline personalities, sociopaths, and other codependents, including addicts.

Manipulative Tactics

Favorite weapons of manipulators are: guilt, complaining, comparing, lying, denying (including excuses and rationalizations), feigning ignorance, or innocence (the “Who me!?” defense), blame, bribery, undermining, mind games, assumptions, “foot-in-the-door,” reversals, emotional blackmail, evasiveness, forgetting, fake concern, sympathy, apologies, flattery, and gifts and favors. Manipulators often use guilt by saying directly or through implication, “After all I’ve done or you,” or chronically behaving needy and a helpless. They may compare you negatively to someone else or rally imaginary allies to their cause, saying that, “Everyone” or “Even so and so thinks xyz ,” or “says xyz about you.”

Some manipulators deny promises, agreements, or conversations, or start an argument and blame you for something you didn’t do to get sympathy and power. This approach can be used to break a date, promise, or agreement. Parents routinely manipulate with bribery – everything from, “Finish your dinner to get dessert,” to “No video games until your homework is done.” I was bribed with a promise of a car, which I needed in order to commute to summer school, on the condition that I agree to go to the college that my parents had chosen rather than the one I’d decided on. I always regretted taking the bribe. When you do, it undermines your self-respect.

Manipulators often voice assumptions about your intentions or beliefs and then react to them as if they were true in order to justify their feelings or actions, all the while denying what you a say in the conversation. They may act as if something has been agreed upon or decided when it hasn’t in order to ignore any input or objection you might have.

The “foot-in-the-door” technique is making a small request that you agree to, which is followed by the real request. It’s harder to say no, because you’ve already said yes. The reversal turns your words around to mean something you didn’t intend. When you object, manipulators turn the tables on you so that they’re the injured party. Now it’s about them and their complaints, and you’re on the defensive.

Fake concern is sometimes used to undermine your decisions and confidence in the form of warnings or worry about you.

Emotional Blackmail

Emotional blackmail is abusive manipulation that may include the use of rage, intimidation, threats, shame, or guilt. Shaming you is a method to create self-doubt and make you feel insecure. It can even be couched in a compliment: “I’m surprised that you of all people you’d stoop to that!” A classic ploy is to frighten you with threats, anger, accusations, or dire warnings, such as, “At your age, you’ll never meet anyone else if you leave,” or “The grass isn’t any greener,” or playing the victim: “I’ll die without you.”

Blackmailers may also frighten you with anger, so you sacrifice your needs and wants. If that doesn’t work, they sometimes suddenly switch to a lighter mood. You’re so relieved that you’re willing to agree to whatever is asked. They might bring up something you feel guilty or ashamed about from the past as leverage to threaten or shame you, such as, “I’ll tell the children xyz if you do xyz.”

Victims of blackmailers who have certain personality disorders, such as borderline or narcissistic PD, are prone to experience a psychological FOG, which stands for Fear, Obligation, and Guilt, an acronym invented by Susan Forward. The victim is made to feel afraid to cross the manipulator, feels obligated to comply with his or her request, and feels too guilty not to do so. Shame and guilt can be used directly with put-downs or accusations that you’re “selfish” (the worse vice to many codependents) or that “You only think of yourself,” “You don’t care about me,” or that “You have it so easy.”

Codependency

Codependents are rarely assertive. They may say whatever they think someone wants to hear to get along or be loved, but then later they do what they want. This is also passive-aggressive behavior. Rather than answer a question that might lead to a confrontation, they’re evasive, change the topic, or use blame and denial (including excuses and rationalizations), to avoid being wrong. Because they find it so hard to say no, they may say yes, followed by complaints about how difficult accommodating the request will be. When confronted, because of their deep shame, codependents have difficulty accepting responsibility, so they deny responsibility and blame or make excuses or make empty apologies to keep the peace.

They use charm and flattery and offer favors, help, and gifts to be accepted and loved. Criticism, guilt, and self-pity are also used to manipulate to get what they want: “Why do you only think of yourself and never ask or help me with my problems? I helped you.” Acting like a victim is a way to manipulate with guilt.

Passive-aggression

Passive-aggressive behavior can also be used to manipulate. When you have trouble saying no, you might agree to things you don’t want to, and then get your way by forgetting, being late, or doing it half-heartedly. Typically, passive-aggression is a way of expressing hostility. Forgetting “on purpose” is conveniently avoids what you don’t want to do and gets back at your partner – like forgetting to pick up your spouse’s clothes from the cleaners. Sometimes, this is done unconsciously, but it’s still a way of expressing anger. More hostile is offering deserts to your dieting partner.

How to Handle Manipulators

The first step is to know whom you’re dealing with. They know your triggers! Study their tactics and learn their favorite weapons. Build your self-esteem and self-respect. This is your best defense! Also, learn to be assertive and set boundaries. Read How to Speak Your Mind: Become Assertive and Set Limits. Contact me at info@darlenelancer.com for a free report “12 Strategies to Handle Manipulators” and consider following me on Facebook or visiting my website www.whatiscodependency.com.

©DarleneLancer2014

Sharing Secrets – Shattering the Shame

There’s a saying in the rooms of 12 step programs, “We’re only as sick as our secrets.” And it’s true. I experienced it myself, which drove my 40+ years of coping with secondhand drinking and my own experiences with anorexia and bulimia, and so have the thousands of people with whom I’ve worked or been in contact over this past eleven years.

It is a pleasure to share this guest post by Pearl, who writes under the pseudonym, The Secret Slayer, and shares her secrets and her bio here:

Pearl, who writes under the pseudonym, The Secret Slayer, shares her secrets to shatter the shame that may keep others for seeking help.

Pearl, who writes under the pseudonym, The Secret Slayer, shares her secrets to shatter the shame that may keep others for seeking help.

I am a 36 year old mother, grandmother, and teacher. I grew up surrounded by substance abuse, the product of an extra-marital affair. I was kept a secret for the first 12 years of my life. I became a mother at 13 and left home to escape the abuse at 15. Education freed me from a life of poverty and abuse so I have dedicated my life to it. I currently work as a special education supervisor and I publish The Secret Slayer, a blog focused on recovery from addiction and child abuse. Through sharing my story I hope to help others. You may wish to follow me on Twitter @SecrtSlayrPearl or on Facebook.

 

Sharing Secrets – Shattering the Shame by Pearl, The Secret Slayer

I come from a long line of overeaters. My grandmother is morbidly obese. Two of my four aunts and one of my cousins has had weight loss surgery. My mother struggled so hard to control her weight that she ended up addicted to “diet pills” in the 80’s. My childhood was cut short and I endured much trauma due to her addiction.

My earliest memory of overeating was Christmas dinner as a 4 year old. I ate candied yams until I vomited. I remember exactly where I was, standing at the side of the dinner table as my mom cleaned up the leftovers. I enjoyed the taste of the yams so much I couldn’t stop myself. I ate every last one even though my stomach was aching with the excess.

I don’t remember feeling shame that day but I do remember feeling shame every holiday after that when I did the same thing. I remember spending hours in the bathroom at an aunt’s house after Thanksgiving dinner when I was 8 years old. I ate so much my body was rejecting it all. I was not vomiting to control my weight. I was vomiting as my body could not handle the amount of food I was putting in it.

This continued throughout my childhood. I was one of those kids who always cleaned their plate and went back for not only seconds but thirds. I was bigger than the other kids and they were not afraid to remind me of it on a daily basis. Rarely a day passed that I didn’t hear vial comments such as “Oh be careful she might sit on you” or “Ohhh the Earth is shaking. Here she comes.” The world is not kind to fat people. Children are especially unkind to fat peers. I felt ugly and gross all the time.

Then something miraculous happened the summer after 5th grade. Boys started to find me attractive. I had thinned out with the onset of puberty and even the older boys were stopping me on the street to tell me how pretty I was. It was bizarre to say the least. But heck, now I understood what the hype about being skinny was! It was pretty darned awesome! And so started my trip through anorexia and bulimia. I needed to be thin at ALL costs.

For periods of my teen years I existed on 3 grams of fat a day or a strict 1200 calorie diet. I started working out every morning before school in the 7th grade and started using laxatives in the 9th. I would do whatever it took to be thin.

I struggled with food for all of my life but things really came to a head during my first year as a teacher. I was 27 when I started teaching special education in the inner city. It was stressful to say the least. I had no idea what I was doing and every day felt like a jail sentence. I started eating as a means of dealing with the stress. The sweets brought me pleasure and respite if only for a few minutes.

I noticed it was becoming a problem when I was making 3 trips a day to get a candy bar out of the vending machine. I was so embarrassed that my coworkers might take notice. I felt so worthless. I beat myself up over having no will power.

On top of my trips to the vending machine I also stopped at the ice cream shop every single day after work. It was my bar. I was their “Norm!” I left all of my troubles there in the bottom of a sundaec up. I cried and cried because I knew it was terrible but I couldn’t stop. I wanted Just One More. I would quit Tomorrow.

Then a curious thing happened. I started getting frequent painful sore throats. I went to the doctor a few times but I was not sick. I did not have strep. It took a few months before my doctor made the diagnosis. I had abrasions extending the length of my esophagus clear into my sinus cavity. The culprit, acid reflux. I was causing serious damage to myself with the constant bingeing. I am not exaggerating when I tell you I experienced the sensation of hunger twice in six months. I simply did not stop eating long enough.

I went on medication to help with the acid reflux and I signed up to attend intensive outpatient therapy for eating disorders. I remember sitting in the waiting room sobbing as I filled out the intake forms. I just didn’t want to have this problem. Therapy included 3 dinners and 9 hours a week with the group. The program was 6 weeks long. I was taught a lot about listening to my body. I was also encouraged to attend Overeaters Anonymous, which thankfully I did.

Overeaters Anonymous changed my life. The first meeting I attended was a well established one with plenty of old timers and lots of new comers. I felt so welcomed. I heard people tell stories like mine. I heard people talk about never being able to get enough and being so ashamed they wanted to die. I got that. I really did.

I also heard many people talking about food plans which consisted of no refined sugar. I thought “Well that’s not for me. What else do you have?” I was existing on mere sugar at that point. There was no part of me that thought I had the ability to give it up.

I found a sponsor who had what I wanted and I did what she told me. She told me to keep coming back. After 4 months of coming back I still didn’t have the sobriety I heard so many others speak of. I was feeling pretty crappy. After bingeing on sugar in the parking lot of a local drug store, defeated I called my sponsor and told her I was really doubting this program was going to work for me. I remember her words so clearly, “Don’t quit before the miracle happens.” I have no idea why it resonated with me at that time but it did. I put down the sugar that night. It was challenging but I did it, an hour at a time. A day was too much for me to consider in the beginning.

I was able to stay away from the sugar by attending meetings, making calls, reading literature and of course, giving service. The acid reflex disappeared and I began to heal physically, mentally, and spiritually.

I did relapse 3 years later upon leaving my marriage but through returning to the rooms I got clean again. That was over 3 years ago. Today I make recovery a big part of my life. I know that sugar affects my brain in a way that makes it impossible for me to enjoy it in moderation. I know that being addicted is not a matter of will power. I also know that I did not ask for this disease and so I will no longer feel shame about it.

I write in the hopes that you may heal. If you are suffering with any type of addiction, reach out. You are not alone. Together we can do what we could never do alone.

Love, Pearl