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PostPosted: Tue Sep 25, 2012 5:19 am 
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Interesting article in Scientific American:

Quote:
Can You Cure Yourself of Drug Addiction?

By Nina Bai

When asked recently on The Today Show how he cured himself of his addiction, Two and a Half Men sitcom star Charlie Sheen replied, "I closed my eyes and made it so with the power of my mind."

Until last month, he was the highest paid actor on TV, despite his well-known bad-boy lifestyle and persistent problems with alcohol and cocaine. After the rest of his season's shows were canceled by producers, Sheen has gone on an interview tear with many bizarre statements, including that he is on a "winning" streak. His claims of quitting a serious drug habit on his own, however, is perhaps one of his least eccentric statements.

A prevailing view of substance abuse, supported by both the National Institute on Drug Abuse and Alcoholics Anonymous, is the disease model of addiction. The model attributes addiction largely to changes in brain structure and function. Because these changes make it much harder for the addict to control substance use, health experts recommend professional treatment and complete abstinence.

But some in the field point out that many if not most addicts successfully recover without professional help. A survey by Gene Heyman, a research psychologist at McLean Hospital in Massachusetts, found that between 60 to 80 percent of people who were addicted in their teens and 20s were substance-free by their 30s, and they avoided addiction in subsequent decades. Other studies on Vietnam War veterans suggest that the majority of soldiers who became addicted to narcotics overseas later stopped using them without therapy.

Scientific American spoke with Sally Satel, a resident scholar at the American Enterprise Institute for Public Policy Research and lecturer in psychiatry at the Yale University School of Medicine, about quitting drugs without professional treatment. Satel was formerly a staff psychiatrist at the Oasis Clinic in Washington, D.C., where she worked with substance abuse patients.

[An edited transcript of the interview follows.]

Is it possible to cure yourself of addiction without professional help? How often does that happen?

Of course it's possible. Most people recover and most people do it on their own. That's in no way saying that everyone should be expected to quit on their own and in no way denies that quitting is a hard thing to do. This is just an empirical fact. It is even possible that those who quit on their own could have quit earlier if they sought professional help. The implicit message isn't that treatment isn't important for many—in fact it should probably be made more accessible—but it is simply a fact that most people cure themselves.

How do addicts stop on their own?

They have to be motivated. It takes the realization that their family, their future, their employment—all these—are becoming severely compromised. The subtext isn't that they just "walk away" from the addiction. But I've had a number of patients in the clinic whose six-year-old says, "Why don't you ever come to my ball games?" This can prompt a crisis of identity causing the addict to ask himself, "Is this the type of father I want to be?"

If not, there are lots of recovery strategies that users figure out themselves. For example, they change whom they associate with. They can make it harder to access drugs, perhaps by never carrying cash with them. People will put obstacles in front of themselves. True, some people decide they can't do it on their own and decide to go into treatment—that's taking matters into one's own hands, too.

What do professional drug addiction programs offer that is difficult to replicate on one's own?

If you're already in treatment, you've made a big step. Even for court-ordered treatment, people often internalize the decision as their own. You get a lot of support. You get instruction in formal relapse prevention therapy. You might get methadone for withdrawal and medications for an underlying psychiatric problem.

Most experts regard drug addiction as a brain disease. Do you agree?

I'm critical of the standard view promoted by the National Institute on Drug Abuse that addiction is a brain disease. Naturally, every behavior is mediated by the brain, but the language "brain disease" carries the connotation that the afflicted person is helpless before his own brain chemistry. That is too fatalistic.

It also overlooks the enormously important truth that addicts use drugs to help them cope in some manner. That, as destructive as they are, drugs also serve a purpose. This recognition is very important for designing personalized therapies.

Don't most studies show that addicts do better with professional help?

People who come to treatment tend to have concurrent psychiatric illness, and they also tend to be less responsive to treatment. Most research is done on people in a treatment program, so by definition you've already got a skewed population. This is called the "clinical illusion," and it applies to all medical conditions. It refers to a tendency to think that the patients you see in a clinical setting fully represent all people with that condition. It's not true. You're not seeing the full universe of people.

Based on his public interviews, does it seem likely that Charlie Sheen cured himself?

I doubt it. Of course, I haven't examined him, but based on what one sees, one would be concerned about ongoing drug use and underlying mental illness.

Is there brain damage from drug use? Is it possible to recover from such damage?

The only drugs that are neurotoxic are alcohol, methamphetamine, probably MDMA [ecstasy], and some inhalants.* Cocaine can lead to micro strokes. That's brain damage. Yes, addiction changes the brain but this does not doom people to use drugs forever. The most permanent change is memories. Some people have stronger memories and they are more cue-reactive [more reactive to stimulus that triggers the reward pathway]. Nonaddicts won't show that level of cue-reactivity.

For some people the addiction and withdrawal will be more intense through genetically mediated problems. Those people have a harder time stopping.

What else might account for Charlie Sheen's strange behavior in those interviews?

One would want to explore the possibility of underlying psychiatric problems. The grandiosity, the loose associations, the jumbled flow suggest a thought disorder. Heavy, heavy drug use could cause that. Stimulant use can cause temporary thought disorder or intensify an underlying thought disorder or hypomanic state. To try to make a good diagnosis, whatever ongoing drug use there is would have to stop. After the withdrawal phase is resolved clinicians would then need to see if an underlying thought or mood disorder persisted. That would aid in parsing how much of a confusing clinical picture is due to drug use and how much is due to a primary mental disorder.

*Correction (3/7/11): This sentence was edited after posting. LSD and methadone were removed, whereas methamphetamine and MDMA were added to the list of neurotoxic drugs.


Interesting. Here's a quite well known and respected doctor disagreeing with the disease model? NO WAY.


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PostPosted: Tue Sep 25, 2012 5:32 am 
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[font=Comic Sans MS]Hmmmm, interesting. I enjoyed reading that article TJ. Thank you.[/font]

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PostPosted: Tue Sep 25, 2012 3:19 pm 
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I sometimes think that there are multiple kinds of issues going on that are all lumped under the umbrella of "addiction." Like for some people addiction is more of a behavioral disorder, coping skills gone awry leading to dysfunctional behavior, while for other people addiction is really more of an organic brain disorder. And maybe sometimes it's a combination of both things.

It's very intriguing to me. I often wonder why person A might be able to use oxy (for example) for a long period of time and remain highly functional, only evolving into abuse very slowly, and then realize that they have a problem and get treatment even without suffering huge personal losses or legal repercussions. Then you have person B, who uses oxy and very quickly escalates into abuse and full-blown addiction and even though they've lost pretty much anything they seem unable to stop, even with support and treatment. Do these two people really suffer the same disease?

I also dislike the idea that because addiction is a disease, we are powerless in the face of it. That's also one of my big beefs with 12-step recovery, the idea of accepting our powerlessness over addiction. I think many times people with addictions have been largely disempowered in their lives, or at least have felt disempowered. I think restoring some sense of agency to people to take control of their lives and decisions is crucial to recovery; I know it was for me.

There has to be some way to disentangle the disease model from the idea of powerlessness. I think this is an issue in the disease model of other disorders too, like depression for example. I bought into it for the longest time, quoting that thing about how I needed to take antidepressants like a diabetic needs insulin. And I did need antidepressants at times, but I was also using this line of thinking to absolve myself from responsibility to make other changes in my life that would address both the causes and effects of depression in my life. It was only when I started to combine antidepressant medication with CBT, changes in diet and exercise, light therapy and other behavioral changes that I started to see real improvements like a shortening of the time a bout of depression would last and a lengthening of time between cycles of depression. And now I've been off antidepressants for the longest period of time in the past 10 years or so without having a depressive episode.

Ok, so I'm kind of rambling but I guess my point with all of that above is that I think we need addiction treatment that is fully comprehensive, and the ability to tailor it to the individual. It is wonderful that people can recover on their own - we should study them and find out what they did, what makes them successful. And for the the addicts who need help, there needs to be a variety of treatments, not just "take this medication and get thee to a 12-step meeting."

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PostPosted: Tue Sep 25, 2012 6:36 pm 
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I wanna comment more but I'm in a rush.

How did light therapy work for you DoaQ? It's something I've been meaning to look into, because while I can dip into depression any time of the year, I seem to consistently dip around the month of April (my fall).


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PostPosted: Tue Sep 25, 2012 6:51 pm 
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Great article TeeJay. Im always on the lookout for stuff like this.

I don't mind calling addiction a disease. I think of it as a mental illness. I believe there are different degrees of addiction and treatment plans should be individual.

I am sooooo sick of hearing that NA/AA is the ONLY way to recovery. In my out patient group they require two support meetings a week. It can be NA/AA, church, smart recovery, celebrate recovery, counseling, or whatever else the patient proposes. I think this is forward thinking. Not all people are gonna make it in AA. I also think people can recover without formal treatment.

I also liked how opiates are not on the neurotoxic list. People get so worried that sub is damaging their brains somehow. It isn't!


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PostPosted: Tue Sep 25, 2012 11:37 pm 
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Articles/stories with the "I just quit'' thing,,,,
always make me think of my husband.
Ten years ago, hell I guess it was 12 ????? anyways,,, a long time ago, when I very first started getting perscriptions for pain killers.......
I'd take a few, my husband (mike) would take a few, and it'd be 'all good'
two hours later, I'd say "Im gonna take two more"
and look at him, like do you want some?
he'd always say "no Im good"
Id think WHAT the HELL is wrong with YOU???? LOL
well, fast forward around two years,,,,,,,,,, and I had turned from a 'binge user' to a full blown, every day addict.
I dont ever know if he was reall addicted, but he definitely abused the pills a time or two.
BUT........
the FIRST time, we were out, and couldnt get any more, we started the withdrawls. I was FREAKING out. and he was just
MAD. he was MAD, that he let something else take control ??? dont know if thats the right word..........
anyways.
that night, he says
THATS IT IM DONE. NOT ONE MORE PILL, EVER AGAIN.
I thought, holy shit, I hope he doesnt think that means IM QUITING.
(funny, I know)
Anyways, he didnt ever take anything more.
the next day, I walk in the door with oxys, and he got PISSED, when I offered him some.
and my addiction obviously got worse and worse from then on.
He has taken a pain pill or two, since then,
But thats the thing, HE CAN take ONE pill, and be fine. whatever.
I never could.
ever.
Anyways, just wanted to use that as an example. He abused pain meds for a fairly short time, compared to me anyways. and he just 'quit'
and was done with it. in the last ten years, he MAYBE has taken ten vicodin. and he pretty much refuses to take any kind of pain pill since I got on suboxone. he's a good supporter.
I've told him, the few times he's gotten an Rx for something, that it wouldn't bother me, but I guess he's not willing to risk it.

Thanks,,,,,,,,,
for bringing this up.
Good topic :wink:

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