Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

One of the key messages I share in a number of my talks is the role early childhood trauma plays as one of the risk factors for developing the disease of alcoholism and/or an ongoing problem with alcohol abuse. And here is why.

We are born with approximately 100 billion brain cells but only a fraction are “wired.” It takes neurons (brain cells) talking to neurons — or “wiring” — for us to do whatever it is we do. Dr. Norman Doidge uses the phrase, “Neurons that fire together, wire together,” in his book, The Brain That Changes Itself. This “firing together, wiring together” causes the brain to form “brain maps” for everything we think, do, feel or say. For example, the act of my typing this blog post involves my fingers, my eyes, my mind recalling research, my body and its posture — all working seamlessly together in a manner I don’t even think about. It just happens; happens thanks to neural networks wiring together because they fired together to form the brain map for how I “write.”

Now, read this quote that I received in a newsletter from SAMHSA informing readers that  National Children’s Mental Health Awareness Day is on May 6, 2010.

“Research has found that core brain development, 85 percent of which occurs in the first three years of life, shows differences in brain structures and function based on the child’s experiences in relationships with others and with their social context.” Shonkoff, J. & Phillips, D. A. (Eds.). (2000). From Neurons to Neighborhoods. Washington, DC: National Academy of Science

It makes sense when you think about it. For although we are born with approximately 100 billion brain cells, at birth about all we can do is sleep, eat, poop and urinate, cry and breath.  If our neurons were all wired at birth, we’d come out running, laughing, reading, talking and doing calculus. Now read Shonkoff’s quote again.

Because the brain continues to form brain maps and input gets more advanced and complicated (think school, sports, music, relationships…), in the first decade of life, trillions of neural networks are formed. So here is where childhood trauma comes in.

If a child is being raised in a home with undiagnosed/ untreated alcohol misuse, their neural networks for how to see, process and cope with the world are all being influenced by how their family members interact. For a better understanding of what I’m saying here, please read this excellent piece on Huffington Post by Dr. Tian Dayton, “Diane Schuler, The Heartbreak of Denial.”

Bottom line… long before the age at which we start to have a memory of our lives, our neural networks are being formed in response to what is going on around us. And that “what is going on around us” has a profound impact on how our neural networks wire. All of this to say, here is another reason to address alcohol misuse — whether it is the person drinking too much or the person reacting to it — for our children’s sake.

by Lisa Frederiksen

One of the things that can keep family members and alcohol misusers stuck is the debate about how much is too much and what makes a person an alcoholic and does not being an alcoholic make excessive drinking okay. In a recent post, “Controlled Drinking Can’t Work for an Alcoholic,” I discussed what makes a person an alcoholic, and why a person who is not an alcoholic can perhaps learn to drink in moderation.

Recently I found this website, Moderation Management. They offer suggestions for how to drink in moderation, as well as face-to-face and online support meetings. They provide the following answers on their website to these two questions:  “Why is a moderation program needed?” and “What is Moderation Management?”

Why is a Moderation Program needed?
According to the NIAAA and many other independent researchers, there are four times as many problem drinkers as alcoholics in this country. Yet there are very few programs that specifically address the needs of beginning stage problem drinkers, while there are literally thousands of programs for the smaller population who are seriously alcohol dependent.

By the time people reach serious stages of alcohol dependency, changing drinking becomes more difficult, and treatment is usually costly. MM believes that this situation needs to be remedied in the interest of public health and human kindness with early intervention and harm reduction programs. Moderation programs are less costly, shorter in duration, less intensive, and have higher success rates than traditional abstinence-only approaches.

Nine out of ten problem drinkers today actively and purposefully avoid traditional treatment approaches. This is because they know that most traditional programs will label them as “alcoholic”,  probably force attendance at 12 step and abstinence based meetings, and prescribe lifetime abstinence as the only acceptable change in drinking.

They may also have real concerns about how their participation in these programs will affect their jobs and ability to attain future medical and life insurance. MM is seen as a less threatening first step, and one that problem drinkers are more likely to attempt before their problems become nearly intractable.

Not surprisingly,  approximately 30% of MM members go on to abstinence-based programs.  This is consistent with research findings from professional moderation training programs. Traditional approaches that are based on the disease model of alcohol  dependence and its reliance on the concept of powerlessness can be particularly counterproductive for women and minorities, who often already feel like victims and powerless.

Outcome studies indicate that professional programs which offer both moderation and abstinence have higher success rates than those that offer abstinence only.  Clients tend to self-select the behavior change options which will work best for them.

What is Moderation Management?
Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.

Please note: Neither BreakingTheCycles, www.breakingthecycles.com, nor Lisa Frederiksen endorses any specific treatment program over another, nor any particular method for stopping, controlling or changing drinking patterns, rather strives to bring the latest information on various treatment options to readers’ attention.

The following is a guest post by Bill White, M.S., a counselor, author, mentor, blogger and speaker specializing in depression, anxiety and general mental health issues. He hosts a blog, http://chipur.com, and does a lot of E.R. psychiatric emergency work in Chicago’s suburbs where he also spends time with his two teenage children.

“S.A.I.L.” Stop-Assess-Interpret-Logic

Here’s a technique I came up with that’ll be easy to etch upon your mind, allowing it to be there for you at a moment’s notice. The next time you begin to sense the tiptoeing of a panic attack in your immediate vicinity…stop everything. Now, slowly take a few refreshing abdominal breaths and begin whispering to yourself, “S.A.I.L.”…”S.A.I.L.”…”S.A.I.L.” And as you’re saying it, imagine feeling warm and gentle breezes of relief upon your skin. And here’s the magic of the acronym…

STOP everything in your life right now.

ASSESS exactly what’s going on within, and outside of, you.

INTERPRET if the situation is truly threatening and merits alarmed reaction.

LOGIC your way to an appropriate emotional and behavioral response.

Of course, I could go on and on with more details on the technique; however, newsletter constraints won’t allow it. But I think you get the idea. Give it a go, and if you want to learn more about S.A.I.L. and tons of other panic and anxiety tidbits of relief, check out Panic! …and Poetic Justice.

by Lisa Frederiksen

What do you say when someone you care deeply about keeps telling you time and again they’re sorry.

They’re sorry, but they were drunk; or they’re sorry, but they must have blacked out; or they’re sorry, but they don’t remember; or they do remember and they’re so very, very  sorry for…

- vomiting in your car (”Ah man… I don’t feel so good…”)
- peeing in your closet (”Hey… I thought it was the bathroom.”)
- picking a fight with your sister at your mother’s birthday dinner (She started it…it was none of her business whether I was having another beer, and what about you? You went along with her.”)
- trashing your house (”What do you mean I did this. What happened?”)
- trying to pick up your best friend  (”Hey, she kept coming onto me,  and that’s the last I remember.”)

I don’t have any answers, other than to say, as long as a person drinks more than their brains and body can process, there will always be a next time, sometime, and once again, they’ll be sorry, but…

by Lisa Frederiksen

One of the more confounding aspects of all this is why some people who drink too much and behave terribly and cause problems within their families because of their drinking can learn to “re-drink,” get their drinking and lives back under control, and why others, who do all of the same things, can’t.

This fact is what causes so many alcoholics and family members, alike, to go along with, “This time, it’ll be different. I’m going to only drink on Friday nights and holidays, but that’s it!” (or some variation thereof). And, sometimes that promise lasts for a while. Sometimes the person even stops drinking all together — for years. But, then “it” starts, again… the glasses get larger and the sneaking creeps back in and pretty soon, it’s right back where it started.

Why?

The reason it works for some — and some can be very heavy drinkers — and not for others is the disease of addiction. Alcoholism is one of the diseases of addiction, which is a chronic relapsing brain disease. This means an alcoholic’s neural networks have been so corrupted – hijacked – by their addiction, the chemical and structural changes that have occurred in their brains makes it impossible for them to EVER drink ANY amount of alcohol, if they want to be able to stop their drinking behaviors long-term.

Watch these two videos to better understand (Note: when Dr. Volkow refers to “drugs,” that includes alcohol):

• The Hijacked Brain — found in the right column, top video.
• Brain Imaging (You can stop watching this one when Dr. Volkow starts her interview with a patient.)

So how can a person (family member or the drinker) tell whether a person should stop trying for “controlled drinking” and get treatment for alcoholism?

One thought is to understand the Risk Factors for developing the disease. The more Risk Factors a person has, the more likely they are to develop the disease of alcoholism; one of the diseases of addiction. Risk Factors include:

• Early use – because of the critical brain development that occurs from ages 12–25, alcohol affects the developing brain DIFFERENTLY than it affects an adult brain. The developing brain is especially vulnerable to the chemical and structural changes caused by alcohol misuse. (See this related link for more information.)
• Genetics – persons whose parent or sibling are alcoholics are 4-7 times more likely to become alcoholics themselves.
• Social environment – people who live, work or go to school in an environment in which the heavy use of alcohol is common – such as growing up in a home where heavy drinking is seen as ‘normal’ or living in a school setting where it is viewed as an important way to bond with fellow students – are more likely to abuse alcohol themselves. That abuse of alcohol causes chemical and structural changes in the brain.
• Mental illness – just over one-half of persons diagnosed as alcoholics or alcohol abusers have also experienced a mental illness (e.g., depression, PTSD, ADHD, bipolar) at some time in their lives. With mental illness there are also chemical and structural changes in the brain. Persons with a mental illness may turn to alcohol to self-medicate and/or their alcohol misuse may make their mental illness worse.
• Childhood trauma – abuse (such as verbal, physical or mental abuse) or neglect of children, persistent conflict in the family (such as that surrounding a family member’s unacknowledged alcohol abuse or alcoholism), sexual abuse and other traumatic childhood experiences can shape a child’s brain chemistry — especially during the early development ages of birth to about 12 — and subsequent vulnerability to alcohol misuse.
• Alcohol Abuse – binge drinking, for example, is alcohol abuse, and it is the kind of drinking that causes drinking behaviors — which in turn causes problems. It is also the kind of drinking that can change the chemical and structural make up of the brain, which is a contributing factor to the developing the disease of alcoholism.

Bottom line…. if a person has tried repeatedly to control their drinking but keeps finding it does not work for one reason or another, it might help to determine how many Risk Factors they have.  If a person can “see” any, they may be able to better “see” the problem and thus more inclined to get help or talk to a professional. Equally as important is for the family member to do this exercise, as well. That way the family member can give up believing that this time the controlled drinking plan will work and instead, do what they need to do to help themselves.

One last suggestion…. a person (family OR drinker) can always go to NIAAA’s website, Rethinking Drinking, to do an anonymous assessment of their drinking patterns and find suggestions for further help.

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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source.

by Lisa Frederiksen

Here are three key concepts for alcoholism recovery that a person who has been diagnosed with alcoholism or one who has decided on their own they are an alcoholic may want to focus on:

1. Accepting that alcoholism is one of the diseases of addiction; addiction is a chronic relapsing brain disease (which is what makes it impossible to drink any amount of alcohol and succeed in long-term recovery).

2. Accepting one has the disease (which is what helps a person accept they cannot  successfully drink some amount of alcohol some day).

3. Understanding there are many options to help with successfully treating the disease and that various options work better than others, depending on the individual and on their stage in their recovery process.

For more information on these three concepts:

for #1, click here

for #2, click here

for #3, click here and/or click here.

Rev. 2/26/10

by Lisa Frederiksen

Likely you are well aware that I preface the key points of just about every one of my talks, articles and posts with a comment about the “new brain research of the past 10-15 years has ______.” So when I read this article by Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), published on the Dana Foundation website, in which she summarizes some of the biggest advances in brain research in the past decade — the decade after the “Decade of the Brain,” I knew had to share it with you.

The following is just the beginning of what Dr. Volkow has to say… I urge you to read the rest of her article, “A Decade After the Decade of the Brain, Challenges and Opportunities in Drug Addiction Research:”

Neuroscience is at a historic turning point. Today, a full decade after the “Decade of the Brain,” a continuous stream of advances is shattering long-held notions about how the human brain works and what happens when it doesn’t. These advances are also reshaping the landscapes of other fields, from psychology to economics, education and the law.

Until the Decade of the Brain, scientists believed that, once development was over, the adult brain underwent very few changes. This perception contributed to polarizing perspectives on whether genetics or environment determines a person’s temperament and personality, aptitudes, and vulnerability to mental disorders. But during the past two decades, neuroscientists have steadily built the case that the human brain, even when fully mature, is far more plastic—changing and malleable—than we originally thought.¹ It turns out that the brain (at all ages) is highly responsive to environmental stimuli and that connections between neurons are dynamic and can rapidly change within minutes of stimulation.

Read more…

One very difficult part of family recovery from a loved one’s alcohol misuse is learning to talk to one another in a manner that the other can ‘hear.’ And, a big part of that is the blaming that went on for so long… “If you’d just stop drinking so much, things would be fine!” or “If you’d stop nagging me all the time, I wouldn’t drink!”

The following video, “Blame and How It Hurts Relationships,” can help. It was created by Jim Hutt, Ph.D., MFT, www.counselorlink.com. Dr. Hutt specializes in relationships, family, parenting and addictions counseling.  What he has to say about communicating with a partner will be especially helpful to couples whose relationship has been deeply affected by a partner’s drinking.

This is a guest post from my good friend, The Discovering Alcoholic, who writes a top rated recovery blog, www.discoveringalcoholic.com, covering alcoholism, substance abuse, treatment and recovery issues.

Joanne Kimberlin of The Virginian-Pilot has written an in-depth piece on prescription medication abuse in the US with a focus on the state of Virginia. It begins with an assessment of current conditions by Cathy Pederson, a Norfolk undercover drug agent who explains addicts no longer fit the old stereotypes.

More and more, she finds herself busting business executives, lawyers, teachers, gray-haired grandmothers, teenage girls – all caught in the grip of a blossoming addiction to opiates like OxyContin, Vicodin and Percocet. Pederson has noticed another common thread: “They didn’t meet opiates at a party. They didn’t start taking them for fun. There’s usually a car accident or a surgery somewhere in their background, and they became addicted to their pain meds.”

A sidebar gives the stats on the alarming number of people abusing prescription drugs, mostly pain killers.

Who are the drug abusers?

- $50,000-plus The family income bracket reported by 42 percent of oxycodone abusers.

- 1 in 4 Troops admit abusing prescription drugs within a one-year period.

- 1 in 10 High school seniors say they’ve abused Vicodin.

- 40-49 The age bracket that accounts for about half of all prescription drug abuse.

- 9 million Americans currently abusing prescription drugs. Pain relievers are by far the most popular.

- 180 Estimated number of health care professionals arrested for prescription crimes in 2009 by a special unit of Virginia’s State Police.

The article is extremely detailed and informative covering the urgency and size of the problem, how it is occurring, and what authorities are doing about it. I found it odd but not surprising though that not once was methadone treatment discussed, especially since this is one of the most effective and accessible means known to treat long term addiction to opioids. It has been my experience that there is general misunderstanding of this treatment that many consider either taboo or just plain counterproductive despite the obvious benefits.

There’s an epidemic of opioid (pain med) drug abuse and addiction sweeping our nation and if we have any hope of keeping up with those that are “Jones-ing”… then we better start looking at methadone maintenance and medically assisted recovery programs as a solution instead of a stigma.

by Lisa Frederiksen

This is a common question of many family members with a loved one who has entered a treatment program or started AA or promised to really stop this time.

The short answer to the question is, “You can’t.”

And, it’s this short answer that runs counter to everything a family member believes — beliefs generally anchored in the notion that a person can stop if only they wanted to badly enough.

So what’s a family member to do?

As counter-intuitive as it sounds, the best ‘thing’ a family member can do to help their loved one succeed in recovery is to help themselves.  To help family members who are new to this whole ‘thing’ get started,  I thought I’d repeat one of my previous posts below titled, “The World of Enmeshment.”

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By the time I finally began (at age 49, now 7 years ago) my own road to understanding what had happened in my life as the result of loving/living with various loved ones who abused or were addicted to alcohol (alcoholics) [whom I collectively refer to as "Alex" in my work], I was one angry, frustrated, resentful person. The more Alex drank or broke his promises not to drink or to cut back on his drinking, the more vigilant I became.

I knew the next “fix” would be the one that would finally work. When that didn’t happen, I would step up my efforts — admonishing, nagging, pleading, arguing, crying, pouting, ignoring, and so on. My common theme was, “If you loved me, you’d stop!”

I deeply believed and figured that if I just managed our household more efficiently or did a better job of scheduling activities or _______________ (fill in the blank, I’m sure I tried it), then he’d quit drinking so much and our lives would finally be happy. And, when I couldn’t control his drinking, I’d step up my vigilance to manage the next inevitable crisis as a way of wresting control of the situation — and in a complex life of marriage, jobs, children, ex-spouses, friends and family, there was an endless source and variety. Little did I understand that focusing on the next crisis was a way of trying to control some aspect of my life, but in fact, it often created problems of a different nature (like my daughter setting aside her own needs in order to make me happy when she sensed I was upset with Alex, for example). But, as long as I focused “over there,” I didn’t have to face the underlying problem right in front of me — alcohol, Alex’s use of it and my reactions to his use.

For you see, unknowingly at the time, I was living in the dangerous world of “enmeshment” — the place where I had absolutely no concept of boundaries. I didn’t know where “I” ended and “someone else” (Alex, for example) began. In my world, the “I” and the “someone else” were one and the same. My identity was thoroughly entangled in the notion that it was my job to make sure others were happy, toed the line and succeeded at work, in school and life in general. It was my job to see the world as others saw it or to make sure they saw it the way I did. I’d reduced my world to rigid absolutes — good or bad, right or wrong, the truth or a lie — because with absolutes, there was a target, an objective, something that could be argued and fought for until a “winner” and a “loser” could be declared. And, by gosh, I was going to “win” this battle over my loved one’s drinking or the next crisis because my whole being was caught up in what others thought of me. If “they” (whomever “they” were) thought I was good or right, then I was good or right.

Luckily for me, Alex entered a treatment program, which plunged me into a whole other world — a world that included terms and concepts like codependency, adult children of alcoholics, 12-step programs, co-addictions, dual diagnosis and the role a family member has in the denial that protects a loved one’s drinking. Lucky for me, it had a strong family-help component, and I was finally DONE — I didn’t know what “done” meant, I just knew I was exhausted, angry, fed-up, DONE — that’s when I finally opened my heart and mind to figuring out just what had happened to me and why and what I could do to change it — finally, there was a chink in the armor that had kept me “safe” all those years.

Stay tuned for my next post on the concept of “powerless over alcohol.”

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