There is an upside to this issue of self-knowledge and it’s this.  When in rehab or treatment you hear yourself described in someone else’s story,  the real benefit is not the insight you get as to why you used the way you did, it’s the connection you make with another recovering person, and the realization that you are not as special or unique as you thought. The less different you feel, the easier it is to become part of a recovery lifestyle. While it is deflating at first to accept the fact that you’re not as unique as you thought, there is actually great comfort in knowing that rather than being a very disturbed, highly individual case of severe emotional imbalance (for which you have yet to find a cure), you’re actually a very ordinary, garden-variety addict (for which there are easily available, highly successful cures). This said; let me share with you some things I’ve learned about myself and my addiction patterns.

Addiction has more to do with why you used then what you used. What it is you felt inside that allowed drugs to have a SPECIAL EFFECT on you, an effect that you almost certainly remember from the first time you felt it.  Once having had that feeling, you thought often about having it again and again, and once you started using on any given day, there was no way of actually telling where you would end up- that day, that night, that week.  From the earliest days of your drug use, and for a very long time thereafter, drugs wasn’t the problem, drugs were the solution, and they remained the solution for a very long time, until (to your deepest regret) they stopped working.  For a variety of reasons – no matter the relief they were providing in terms of living in your own skin – they began to cause havoc in every other area of your life (your family; your job; the police).  Then they became the problem.  But before drugs had this special effect on you, and in order for it to meet so many of your unmet needs, you probably had been feeling and experiencing some combination of these things for a very long time:

1. Restless, irritable and discontent. - You may remember having felt this way since you were a kid.
2. Hypersensitive to criticism. - You always felt that everyone had some form of armor that you somehow didn’t get when they were handing it out.  As a matter of fact there was some kind of instructions in general, that were given out to everybody and you must have been in the bathroom, or out somewhere, when the instructions on how to live were discussed.
3. Prone to Resentment. - Capable of holding a major grudge for a very long time, probably unbeknownst to the grudgee.  Although you were sure it’s just killing them that you weren’t speaking to them or were angry with them.
4. Inferiority wrapped in grandiosity - A strange combination of feeling “less than” and “better than” the same people at the same time.  A problem that you specifically remember drugs addressing with a certain special warmth that almost immediately allowed you to feel pretty much like other people – or so you thought. The so-called “feeling on the inside like other people looked on the outside” phenomenon.
5. Uniqueness/Isolation - you often thought to yourself, “As troubled as I am- and I know I’m troubled – nobody could possibly know what I’m feeling inside, or could really understand me. I am completely alone, completely separate. My problems are not like yours, and cannot be solved using your solutions. My situation is hopeless.”
6. Intolerant of flaws in others – You were the director, if everyone simply followed your direction, everything would be just fine.  But of course, everyone refuses to do it your way.
7. Sneaky and self-pitying - When you weren’t planning and plotting, you were feeling sorry for yourself.
8. Immature- Sensitive to even the smallest perceived slight.  You could be crushed if people who you didn’t even care about that much, rebuffed you.
9. Selfish and self-centered- It was always, always, about you; your needs, your problems, your issues. You never got your fair share of attention.
10. Filled with undefined fears- There were plenty of things you knew you were afraid of, but there were others that you could never seem to get a handle on.
11. An actor, A chameleon, leading a double life. What people saw was only what you wanted them to see, what you believed was needed or expected at any given moment. There was no real you inside, and you were the only one who knew it.
12. A worshipper of people, things, money – Jealous and envious of everyone. Especially, but not limited to, anyone who you felt had more than you did. You knew in your heart that they didn’t deserve it. They were fools or worse, yet you desperately wanted to be just like them.

For us, drug addiction has never really been about a few lines, a few rocks, or a few pills drinks more or less.  This was always about a magic potion, one that almost instantaneously made all of this emotional misery and turmoil go away.  All of us had been able to stop using for periods of time; the problem was we couldn’t stay stopped.  And the reason we couldn’t stay stopped was we couldn’t stand living clean.  It was too painful. This was our great dilemma.  We couldn’t keep using, and we couldn’t stay stopped.  It was at this point that many of us landed in residential or outpatient treatment programs, looking for some way not to use drugs, and be able to live relatively peacefully in our own skin, without this cavalcade of personality defects. Of course the question has always been how to make it work. This is no small issue, as we all know.

NOTE: Many of the observations described here have been laid out in accurate detail in the book “Alcoholics Anonymous” (The basic text of the 12 step program Alcoholics Anonymous)

The fact is, the notion of forgive and forget is a myth, probably constructed by an addict looking to get an easy pass.  First, people never forget.  And you don’t want them to forget.  Being the kind of people we are, if they were to forget, we’d be inclined to do the same things to them all over again.  Memory is forever, and that is a good thing for us.  “Forgive”, is a bit more lenient. People forgive you for the things you did to them one memory at a time.  That is they replace one bad memory with one good memory, every time you give them a chance to see you in action in recovery.  So if there were fifteen Christmases that you ruined for everyone, if you show up clean and try to be of service to your family on Christmas, now there are only 14 more good Christmases you have to give people to wipe out the bad memories.  Not quite what an addict likes to hear. Of course it isn’t quite this bleak, but people do need to know you’re serious, in more then just a casual way. Years of using makes skeptics out of our biggest boosters.

On the other hand, virtually every one who really loves you is dying to see you make it.  And they have been dying to see you make it for a long time.  So there’s every reason to believe that you will be getting plenty of support and “atta-boys”, every time you surprise people with a good showing.  Remember in general we are people who others expected to go far.  So if we begin to do well you may actually get some “it’s about time” type stuff.  Any adult behavior on our part will be considered a long time coming and just about any response from others is justified.  But because we are developing some personal consistency, persistence and tolerance for others (more about that soon), our ability to handle the gratuitous digs and sideswipes grows as we do.  We become a lot less sensitive.  We learn to take a punch. Try to never react in anger.  Learn to take a good natured ribbing. Normal people have been doing it for decades. They never collapsed because of it, you won’t either. Your sense of yourself no longer needs to be based on what others think of you. For all you know, they may know virtually nothing about you. Worse, they may know nothing at all. The best thing about the past should be your daily commitment (through action), never to relive it again. Looking forward is a lot easier then looking backward; also it’s a lot easier on your neck.

1. “You’re not really an addict  Although you’ve had considerable problems and consequences, now after a period of sobriety, you really do know how to handle your drug use.  This time it will definitely be different.”

2. “Many of the problems you had when you were using really had nothing to do with drug use.  Now that those problems are no longer around (your wife, your job, your girlfriend), you will be able to use drugs socially.”

3. “Under pressure from others, you’ve really magnified your memory of the problems you had. It really wasn’t as bad as everybody is making it out to be.”

4.  “Let’s be honest. You will never be able to go your whole life without using  (I don’t care what those people say about ‘a day at a time’),so why are you torturing yourself. You’re going to get high at some point. That point might as well be today”.

5. “You’re really too sick to stay clean.  Too much water under the bridge.  While others have been able to get clean, it will never work for you. They’re not as sick as you.”

And this is only the stuff that your disease tells you regarding your drug use behavior.  How about the stuff about resentments, insecurities, perceived slights and rebuffs, the problems of the world, (“everything is so screwed up – the only reasonable response from a ‘caring’ and ‘concerned’ citizen of the planet like me, is to get loaded, and let everyone else go to hell”). Then there’s your own extreme sensitivity (”drugs are my armor- without it I’ll die- or commit suicide- so by using, I’m actually saving my life”).

The voices of the committee are very persuasive and very insidious. They know our deepest fears and weaknesses. They know which messages will resonate and which ones won’t.   If you don’t share these feeling with someone- your counselor, parents wife/ husband, mentor, anyone (which of course the voices are telling you not to do- “don’t tell anyone what you’re thinking. They don’t care. They won’t understand. They’ll think your nuts. They won’t like you”), the implied truth and credibility of the voices will grow. The voices will seem reasonable; you will have very little defense against their perceptiveness.

Never underestimate the power of the illness.  In addition to being cunning, baffling and powerful, it has another killer characteristic, it’s patient.  It has all the time in the world.  It’s not going anywhere.  You’re not going anywhere.  It’s willing to wait as long as it takes.  It will never be happy that you’re sober, and it’s willing to appear dormant and disarmed in order to lull you into the complacency it believes will be required to get you back.

The study, published in the May issue of Medical Care, looked at the economic impact of combined alcohol dependency treatments, including the treatment costs and the economic costs of other health care use, arrests and motor vehicle accidents.

The researchers found that people who were alcohol dependent and received medical management and a combination of acamprosate and naltrexone medications saved more than $3,800 in the median cost of alcohol treatment, other health care costs, arrest costs and motor vehicle accident costs compared to those who just received medical management and a placebo.

“It’s important to understand the effect of alcohol interventions on future social costs,” said Gary Zarkin, Ph.D., vice president of the Behavioral Health and Criminal Justice Research Division at RTI and the paper’s lead author. “Our study suggests that the combined alcohol dependency therapies have additional long-term societal benefits in terms of reduced health care usage, arrests and car accidents.”

The three-year study analyzed data from approximately 800 patients who participated in the nine alcohol dependence treatments in COMBINE (Combined Pharmacotherapies and Behavioral Interventions Study). Previously, the study team estimated the cost-effectiveness of the COMBINE interventions at the end of 16 weeks of treatment. Clinical results for COMBINE were published in the May 2006 issue of JAMA.

“A strength of our study is that we were able to take advantage of the statistical design of the COMBINE clinical trial, which previous researchers were not able to do,” Zarkin said. “But more research needs to be done to understand the magnitude of social cost savings associated with alcohol dependency treatment.”

Alcohol abuse is the third leading preventable cause of death, and in 1998, according to a report by the National Institute on Alcohol Abuse and Alcoholism, the estimated societal cost of alcohol abuse in the United States was $184 billion.

From:
The Office of Research on Women’s Health (ORWH) Prescription drug abuse means taking a prescription medication that is not prescribed for you, or taking it for reasons or in dosages other than as prescribed. Abuse of prescription drugs can produce serious health effects, including addiction. In 2008, according to the National Survey on Drug Use and Health, 15.2 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed.

The NIH’s Office of Research on Women’s Health podcast, “Pinn Point on Women’s Health,” provides updates on women’s health research, and is hosted by Vivian W. Pinn, M.D., director of NIH’s Office of Research on Women’s Health. This month, Dr. Pinn interviewed Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).

Dr. Volkow stated that it is important to understand the sex and gender-based differences regarding drug abuse in order to better target prevention and treatment approaches.

“In general, males tend to take more drugs than females. The exception is the period of time between 12 and 17 years of age. There, we see a higher rate of abuse of most drugs, including psychotherapeutics, among girls than among boys,” Dr. Volkow said.

Drugs of abuse also include pain medications that contain opiates, such as Vicodin or OxyContin, as well as stimulant medications, which are used to treat attention deficit hyperactivity disorder. Dr. Volkow noted that adolescent girls have almost 60 to 70 percent higher rates of abuse of these substances than adolescent boys.

“Adolescents and young adults take stimulant medications to improve cognitive performance, to study for an exam, or to prepare for something that requires a deadline involving intense work,” Dr. Volkow said. In addition, girls take stimulants in order to lose weight. Stimulant medications are anorexigenic; meaning, they reduce feelings of hunger.

Not surprisingly, prescription drug abuse can result in addiction. Dr. Volkow has conducted imaging studies that show how repeated drug use affects the brain.

“Not only are there disruptions in the circuits involved in reward (the ability to feel pleasure), and learning; but also in frontal areas of the brain that are involved with executive control and that enable you to make decisions, to judge, to control your desires and your emotions,” Dr. Volkow said.

There exists a misguided belief that abuse of prescription drugs is less dangerous than that of illicit substances because they are prescribed by physicians. “When you take psychotherapeutics outside the surveillance of a physician, these medications can be as dangerous as illicit substances,” Dr. Volkow said. She noted the importance of educating both the public as well as the health care system about how these drugs work, under what conditions their use is beneficial and under what conditions their use can lead to adverse medical consequences.

Treatment for addiction will depend on the type of psychotherapeutic used. “For opiate analgesics, we have medications that look quite promising. We’re currently conducting a trial to investigate the use of buprenorphine in the treatment of addiction to opiate analgesics, and the results appear to be quite promising,” Dr. Volkow said.

There are also several evidence-based behavioral interventions that include motivation intervention strategies, incentive intervention strategies, and group therapy intervention strategies that have been shown to be effective. For information on treatment options in your area, go to http://www.samhsa.gov/ or call 1-800-662-HELP (1-800-662-4357).

To hear Dr. Pinn’s podcasts, visit the Office of Research on Women’s Health home page. (How to use podcasts)

Women who misused the drugs also were more likely to tell investigators that they had been abused sexually or physically, and that they had a past history of psychiatric or psychological problems.

HealthDay News reported April 30 that researcher Robert N. Jamison of Harvard’s Brigham and Women’s Hospital and colleagues studied 662 chronic-pain patients who took opioid painkillers. They found that misuse of the drugs occurred at about the same rate among men and women, but that gender differences showed up when patients were asked about what led them to misuse the painkillers.

The findings appear in the April 27, 2010 issue of the Journal of Pain.

Emotional issues and psychological stress often spark misuse of prescription painkillers among women, whereas men are more likely to cite social and behavioral problems, according to researchers who investigated the underlying causes of opioid painkiller addictions.