Addiction

Posts primarily related to addiction.

Addiction: Neither choice, nor disease.

I spend a lot of time thinking about addiction. Probably an inordinate amount of time, really.

Part of that is due to my role as manager of a wilderness based addictions treatment program for youth with Enviros. Partly it’s due to my diabetes diagnosis a few years back, and the swift realization that comes when you understand that sugar and cocaine aren’t all that different, neurologically speaking.

I thought I’d treat you to a somewhat long(ish) post on my thoughts about what addiction is, and isn’t.

So what, exactly, is an addiction?

The American Society of Addiction Medicine defines it as;

A primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Let’s break that definition down a little bit.

Reflected in an individual pathologically pursuing reward and/or relief. What is pathological? “Behaviour being such to a degree that is extreme, excessive, or markedly abnormal”. Huh. Suddenly checking my smartphone 10x an hour, cruising Twitter late at night, binge-eating almonds while writing blog posts…are these extreme? Excessive? Abnormal? And who gets to decide what’s normal and abnormal? One of the problems that instantly arises when using the word pathological (essentially, abnormal), is that we then need to establish what “normal” is. And that’s a problem in a society that thrives on addiction, from the afore-noted smartphone and twitter checking to excess consumption in all of its various forms.

Let’s dig a little deeper, shall we?

Characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response. Yes. All of these things are symptoms of addiction. Craving. Diminished recognition of significant problems (health, financial, social, relational). Impairment in behavioural control, the inability to abstain. Kind of sounds like the typical Friday night dip into the ol’ tub of ice cream, no? It’s all good and then BAM…diabetes. Or 30lbs of extra weight around the middle. Or any number of significant problems.

One of the biggest issues that I see with how we currently conceptualize addiction in society is that there are two school’s of thought. Choice, and disease. Both of which are kind of true, but not really.

Proponents of the choice model of addiction would see addicts as simply being morally inferior, unable to “just say no” and make a better choice. Because someone wakes up one day and decides to go live in the gutter and score some heroin. Makes sense. Here’s the thing; addicts don’t wake up and “choose” to smoke some crack, like you and I might choose what to eat for breakfast. Addiction is a disease of brain reward, motivation, memory and related circuitry. In other words, it’s a problem with our executive function centres in the brain (the places that make decisions).

Of course, the choice model fits very nicely into the (largely conservative, right of center) philosophy and narrative of individualism, free will and personal agency. Not that any of those ideals are inherently flawed (and I’ll try and avoid this become a pseudo-political rant), but when applied to addiction, well, these ideas completely ignore ALL of the related science on the matter, as well as the experiences of addicts and professionals everywhere.

The choice model of addiction locates all of the responsibility and blame within the addict themselves, absolving society of addressing the systemic and underlying causes of addiction. And it certainly doesn’t explain why certain populations are at much higher risk of addiction. You would expect that an equal number of people across the social strata would “choose” to use substances, when the reality is that some communities are hit much harder than others, and some people are much more susceptible than others.

Let’s look at the disease model. I’ll admit to finding more in common with this definition, but I still find it lacking in some key areas.

First, addiction is incredibly complex. If it wasn’t, we would have solved it decades ago. One of the challenging parts for me with the disease model, is that it removes the addict from being in control. Wait, didn’t I just bash the choice model? How can the addict have control when addiction isn’t a choice? Considering addiction a disease, in the same realm of cancer or arthritis, puts the addict on a different cycle of dependence…the health care system. Doctors. Psychologists. Therapists. Experts with the answer. And maybe a pill or two to help along the way. It does a good job of externalizing the problem for the addict…but it doesn’t provide a hell of a lot of hope, does it? You have a disease. A really complicated disease. A disease that we aren’t very close to figuring out.

Other factors that can contribute to the appearance of addiction, leading to its characteristic bio-psycho-socio-spiritual manifestations, include (according to ASAM, 2011):

  1. The presence of an underlying biological deficit in the function of reward circuits, such that drugs and behaviors which enhance reward function are preferred and sought as reinforcers;
  2. The repeated engagement in drug use or other addictive behaviors, causing neuroadaptation in motivational circuitry leading to impaired control over further drug use or engagement in addictive behaviors;
  3. Cognitive and affective distortions, which impair perceptions and compromise the ability to deal with feelings, resulting in significant self-deception;
  4. Disruption of healthy social supports and problems in interpersonal relationships which impact the development or impact of resiliencies;
  5. Exposure to trauma or stressors that overwhelm an individual’s coping abilities;
  6. Distortion in meaning, purpose and values that guide attitudes, thinking and behavior;
  7. Distortions in a person’s connection with self, with others and with the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others); and
  8. The presence of co-occurring psychiatric disorders in persons who engage in substance use or other addictive behaviors.

You don’t often hear other diseases that have factors including the “ability to deal with feelings” and “distortions in a person’s connection with self, with others and with the transcendent”. Got a tumour? Cut it out or blast it with radiation. Got addiction? Build your emotional literacy and connect with a higher power?! That doesn’t sound like a disease to me, at least in my somewhat mainstream understanding of disease.

This is turning into a long post. Why don’t we break it up with a TED talk? Watch Johann Hari as he explains why everything you think you know about addiction is wrong.


Suddenly, neither choice nor disease seem like adequate descriptions of addiction.

What if, instead of viewing addiction as a problem, we started to view it as a symptom?

And let’s go even further. All of us, all of the time, are consciously and unconsciously meeting our needs. From biological to psychological, social to spiritual (quick aside, check out this book…the most important one you’ll ever read, which does a great job of explaining a needs-based approach to just about everything). What if addiction is simply an attempt to meet an unmet need? 

Suddenly the list of “other factors” that influence the development of addiction make a lot of sense. Been traumatized and have poor emotional regulation as a result? Suddenly smoking some weed or having a drink makes a lot of sense. The problem with both the choice and disease models of addiction is that they stop short. They presuppose that the addiction is actually the problem that needs to be tackled, instead of viewing it as the symptom of something deeper that it is.

If we’re really serious about addiction, we’ll stop the practice of both scapegoating addicts through the “choice” lens and trying to explain it away as a “disease”.

As Johann says in his talk…the opposite of addiction is not sobriety, it’s connection.

 

Mindfulness should come with a warning label.

I’ve been working hard to be more mindful these days. I think that part of the problem is getting past my preconceived notions of what “mindfulness” actually is. If it stirs up images of long haired yoga enthusiasts for you, you’re not alone. Yet, I know many people who are truly mindful…present in the moment, grounded, calm…you know, how most of us want to be, yet find to be a hard place to inhabit.

I’ve (finally) gotten around to looking at mindfulness in a more serious way. I’m particularly interested in mindful parenting. I don’t know about you, but my life can be pretty distracting between phone calls, emails, facebook, twitter, 3.5 year old, wife, dogs….etc, etc. I found myself never truly present, always thinking about what happened earlier in the day, what was yet to come or being distracted by someone else’s needs or thoughts.

It’s funny, because being diagnosed with diabetes set me on a path of mindful eating years ago, apparently by accident. I guess I’m a slow learner, as it’s just now creeping into my parenting and life in general.

Enter Jon Kabat-Zinn, professor of medicine at the University of Massachusetts and creator of the Mindfulness Based Stress Reduction (MBSR) program. Here’s Jon discussing mindfulness.

Paying attention, on purpose, in the present moment, non-judgmentally, as if your life depended on it.

On purpose. How many of our thoughts and emotions are “on purpose”, and how many are just reactions to our world? You’d be surprised at how little of our day is intentional, especially the comings and goings of our own minds and attention.

In the present moment. What other moment is there?

Non-judgmentally. A thought is just that, a thought. An emotion is just an emotion. Too often we beat ourselves up for having thoughts and emotions, judging them, feeling guilty or ashamed for having them.

As if your life depended on it. Because it does. As Jon says in the video, the only moment that we’re actually alive in, is this one. The only time that we can love, laugh, cry or experience anything is this present moment.

So what does mindfulness look like in my life? Well for starters, I took Facebook and Twitter off my phone. It was just too easy to be distracted by all the digital noise coming out of that small, handheld device. I also started to cultivate a practice of being grateful every day for something wonderful in my life (of which there is much).

In case you’re not convinced that mindfulness is worth cultivating, here’s the warning label. It’s been shown to;

  1. Relieve stress
  2. Improve heart disease
  3. Lower blood pressure
  4. Reduce chronic pain
  5. Improve sleep
  6. Help with depression, anxiety, substance abuse, etc.

So give it a try, and start by picking up a copy of Jon’s classic book; Wherever You Go, There You Are. Click the link below to buy it off Amazon, and I’ll donate the commission to a local charity. Win-win.

 

Sugar’s not the problem.

I recently did a workshop in Cochrane called The Sugar Fix: 4 Easy Steps to Curb your Cravings. It went really well, likely because that particular topic lies at the intersection of my diagnosis with diabetes, and my work in the addiction sector. We’ve known for awhile now that sugar is addictive. What we haven’t done a great job of (and what I’m trying to do), is use some of the proven methodologies behind addiction treatment and behaviour change and apply them to “sugar”, helping people reduce or eliminate their consumption. I’ve got another one lined up for November 27th in Calary

 

One of the first, and probably most important, things to realize is that sugar is a solution. It is rarely, if ever, the problem. If we consider sugar to be an addictive, mood-altering substance (which it is), then the problem becomes “why do I need my mood altered?”. Stress. Boredom. Depression. Anxiety. Just having a bad day in general. All great reasons to reach for a bag of chips or bowl of ice cream for a little pick me up.

One of the first steps in really tackling a sugar addiction is not to rush out and buy some new cookbooks. It’s to notice. Notice when you’re reaching for the next hit and asking yourself, “why do I feel like sugar right now?”. And if the answer isn’t “I’ve got low blood sugar and need to eat something before I pass out”, then you’re trying to fix a different problem…and I’m going to suggest that sugar isn’t the best solution to try.

Addicted to everything.

15% of adults in the United States are addicted to cigarettes. 7.7% are alcoholics. 5% are regular marijuana smokers or illicit drug users. 2% have an eating addiction. 2% are problem gamblers. 2% are addicted to the Internet. Up to 6% of adults in the Unites States have a love/sex addiction. 10% of Americans are workaholics. 3% are “exercise dependent”. 6% have a shopping addiction. 12.5% are addicted to social media.

We’re up to 71% of the population and we haven’t even talked about tanorexia yet (addiction to tanning beds). Or sugar. Or refined carbohydrates. Or caffeine.

Of course, a lot of people have co-occurring addictions, so we should take into account that there are the odd people who shop on the internet, while jogging on a treadmill, gin and tonic in hand, cigarette hanging out of their mouth and tweeting all about it. But it would seem that, even counting those folks, that having an addiction of one stripe or another is more common than not having an addiction.

I’d highly recommend you take 20 minutes and listen to Dr. Gabor Mate discuss addiction at a TEDx event in Rio.

 

And if you haven’t yet, check out the book In the Realm of Hungry Ghosts, it’s probably the most informative read on the complexities of addiction that I’ve come across.

And remember, it’s not “why the addiction?” that we should be asking ourselves. It’s “why the pain?”.

Expertitis

I recently had the pleasure of being invited up to a gathering of 8 communities in the Dehcho region of the NWT to talk about “on the land” youth addictions treatment. I actually listened more than I talked, and came away with a new-found appreciation for both the challenges and blessings of life in the north.

Something that struck me as I prepared my presentation was the difference between being an expert and having expertise.

I believe the rise of the “expert” is something that’s actually crippling our society from making better decisions and adapting to changing circumstances. There are many, many examples available about the failure of experts to not only predict, but react appropriately, to changing circumstances. Lehman brothers, anyone? Donald Rumsfeld and the Iraq war? The collapse of the Soviet Union? All of these examples have something in common, supposed experts making decisions based on their narrow view and limited understanding of an issue, usually in a position greatly removed from the “front lines” of the situation.

Yet, despite the frequent failings of experts, society turns to them repeatedly for their sage advice. From economics to politics, war to disease…we routinely outsource decision making to people who are “specialists” in their fields. The problem with specialization is that we’re facing systemic and complex problems. These aren’t problems that are easily solved, and they don’t live within narrow fields of study.

“Expertitis” is the syndrome of assuming that you know the answer to something, because you’ve been right (or not horribly wrong) in the past. You might even have a master’s or doctorate on the subject. Regardless, you’ve stopped getting feedback, that essential piece of information in the system that tells you whether what you’re doing is working. Without feedback, you stop learning. And if you stop learning, you can’t adapt. And in evolutionary terms, if you can’t adapt….you die.

Thankfully, it’s not that adaptation is impossible. In fact, it’s how we got to where we are, and there are many great examples of adaptation to be found in the pages of history (recent and a bit further back). Apple was a computer company until it sold mp3 players. The Iraq war was all but lost in 2006 until a small group of soldiers started experimenting with a counter-insurgency campaign that went against their direct orders.

Adaptation starts with being curious about what’s really going on in the system. If you’re truly curious, you remain open to feedback. By accepting feedback you learn, and by learning you can adapt.

And adaptation has been, and will continue to be, the key to survival…whether you’re a society, government, business or person.

I’m not a diabetic. I just happen to have diabetes.

I believe that there’s a very important distinction between having a disease, and identifying yourself with that disease. To some this might be mere semantics, but I see it as having a fairly profound affect on one’s mental fortitude and desire/ability to do something about said disease.

“I’m a diabetic”, to me, is an internalization of a medical condition into a core pillar of my being. It’s a slippery slope towards “I can’t do that, I’m a diabetic”, or “I’m a diabetic, so I might as well start taking insulin”. And with this I’m not saying that insulin is bad, or that I can do anything I want. I’m saying that, for me, it’s a hell of a lot easier to externalize the issue.

We work on externalization all the time with the young people out at Base Camp. “I’m an addict” is a very different frame of mind then “I happen to have an addiction”. The latter gives you hope and power over something, and acknowledges that you might have some strengths to bring to the situation. The former assumes that you might as well give up and learn to “manage” the disease. The first step in many of the 12-step addiction recovery programs is to “admit that we’re powerless over our addiction”. That approach doesn’t work for me, although it’s certainly proven effective for a lot of other people.

For all intents and purposes, I’m not a diabetic. As long as I stick to a paleo diet and get a reasonable amount of exercise, I can expect a long and healthful existence (free of insulin and diabetes complications).

Among other things, I’m a father, husband, brother, son, friend, manager, blogger, volunteer & entrepreneur….not a diabetic.

I just happen to have diabetes.

The problem that isn’t.

At a recent teacher’s conference in Edmonton I asked some workshop attendees if addiction is a problem. Everyone in the room nodded and raised their hands.

If I asked you “is climate change a problem?” or “is deforestation, overfishing, water pollution and habitat loss a problem?”, I’m betting that there would be a collective raising of hands and nodding.

Unfortunately, we’re all wrong. Addiction is not a problem, and neither is climate change. Both of those phenomena are symptoms of a solution to other problems.

Take climate change. Scientific consensus points to the burning of carbon based fuels as the primary driver of the greenhouse affect, which induces global climate change. Why do we burn fuels? To transport ourselves and goods, heat our homes and our water, create electricity, etc. When I have the problem of needing to get somewhere, I start the truck and drive there. Problem solved. When the house is chilly and the furnace kicks on, problem solved. When I feel the need to blog about something, on goes the computer. Problem solved.

As long as we’re looking at symptoms as if they’re problems in their own right, we’re limiting both the discussion on how to solve them, and the tools at our disposal. So long as there’s no real incentive for me to upgrade my 32 year old furnace, it’s likely going to keep chugging away, keeping my house pleasantly warm through the depths of winter. Of course, if my problem suddenly became very expensive natural gas…you can bet that I’ll do something about it. We’re hardwired to solve our individual problems, not so inclined to make sacrifices for the broader good. Which isn’t to say that we’re not capable of doing so, just that we don’t often.

If I’ve learned anything from my work with addicts over the years, it’s that change IS possible. It’s just really hard. And if we don’t address the underlying issue driving the addiction (or climate change, et al), we don’t really have a snowball’s chance in hell of solving it.

The first step in an addict’s journey to recovery? Figuring out what the real problem is.

I’ve been getting some requests to run a webinar on change, addiction and system’s thinking. Interested? Follow the link and let me know what day/time works best. If I get enough interest we’ll make something happen. 

The Resiliency Workshops

I was serious in the last post, when I said that focusing on Lifeworth over Networth was going to be a goal of mine in 2013. So along with spending a lot of quality time with my wife and son, and growing Givyup, and working my day job, and occasionally updating the blog…I’m embarking on a bit of a journey to help build resiliency into our communities. Because apparently I need 8 projects at the same time.

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I’m doing this through a series of workshops, called The Resiliency Workshops. I just did a workshop today at iWeek/Global Environmental and Outdoor Education Conference at the University of Alberta, and I’m lined up for a few teacher’s conventions this month and next.

What are these workshops about? A variety of things, but notably I’m focusing on two areas, Change and Resiliency.

The ChangeMaker’s workshops are designed to provide a sound theoretical background and some hands-on practical skills for making change happen. From individuals changing their lifestyle habits and patterns, to organizations changing their focus and dealing with change, the ChangeMaker workshop is the perfect prerequisite to any change process.

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The Resiliency Workshops are broken down into 3 streams, Resilient Family, Resilient Classroom and Resilient Systems. Although some of the content overlaps, the connections that are drawn and the areas of focus vary greatly, depending on the audience.

Why the focus on resiliency? Isaac Asimov (a notable author) wrote;

“It is change, continuing change, inevitable change, that is the dominant factor in society today. No sensible decision can be made any longer without taking into account not only the world as it is, but the world as it will be…

In this constantly fluxing world, where the pace of innovation and disruption seems to be steady and unrelenting, it’s enormously important that we find a way to foster resiliency in ourselves, families and communities. I witness this first-hand through my work with young addicts and their families, and through my own journey with my diabetes diagnosis and ensuing lifestyle changes.

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So, there it is. I’m taking up my own challenge from some previous posts to get out there and do something about creating the world I want. It’s no longer enough to tweet and blog about it, it’s time to engage others in becoming active participants in their lives and their communities.

You can check them out at www.resiliencyworkshops.com.

For Sale….diabetes. With a side order of irony.

I’m not sure how many people take the time to look around a store when they go in, or whether we’re all so busy now that we just go in, buy what’s on our list, try not to make idle chatter with the cashier (or better yet, use the self checkout!), and get on with our day. I’m guessing not very many of us.

I was in Shopper’s Drug Mart today and took the time to look around and take it all in. The first thing I noticed was how un-beautiful I must be, given how many products they were selling to make my skin look better and make me more attractive.

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Then I wandered to the back of the store and found the health foods and vitamins. Protein powders and bars, acai berry everything, weight loss products…an interesting array of heavily processed and packaged “healthy” stuff. Oh yeah, and Red Bull.

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Next up was the pharmacy. Pretty straightforward really, with most of the marketing material geared towards, interestingly enough, diabetics such as myself.

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Just past the pharmacy, and all that “take control of diabetes!” information was, you guessed it, diabetes central. Row upon row of ice cream, soda, candy, chips.  Yeah, take control alright. Just don’t pass up these really high margin retail items that make our shareholders giddy and the insulin manufacturers laugh all the way to the bank.

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Of course, one could argue that this drug store (and many like it) are simply giving customers what they want. They’ll argue that if they don’t sell it to them, someone else will. They’ll give the standard argument of free will, and not limiting people’s choices. All well and good. With that logic, a lot of the world suddenly makes sense. And I think that maybe we’re missing out on a pretty big opportunity, those of us in the addiction treatment business. Maybe it’s time to revisit the business model. Maybe the trick is to provide the solution, whilst supplying the problem. And if we can make people feel unattractive and overweight while we’re doing it….

Which brings me to my main point. Just because it’s legal, doesn’t mean it’s right. Just because it profits a shareholder, or boosts the bottom line, doesn’t mean it’s moral. And just because you can sell it, doesn’t mean you should.

And just because it’s ironic, doesn’t mean it’s funny.

Wheat Belly.

So I’ve just about finished reading the book “Wheat Belly” by William Davis, a cardiologist in the US. Pretty scary stuff.

Why is it so scary? Well, let’s start with a little bit of what wheat does to your body. Ever heard of the glycemic index? It’s a measure of how much a food affects your blood glucose level, measured in comparison to straight glucose (which would be 100 on the scale). Wheat measures in at 72, higher than table sugar (59). That’s right, eating that whole wheat slice of bread is worse for your body than a spoonful of sugar.

What does consuming simple carbohydrates do to the body anyway? Why be concerned about the glycemic index?

The sequence is pretty simple, as Dr. Davis describes it. “Carbohydrates trigger insulin release from the pancreas, which causes growth of “visceral” (belly) fat. Belly fat causes insulin resistance and inflammation. High blood sugars, triglycerides, and fatty acids damage the pancreas. After years of overwork, the pancreas succumbs to the thrashing it has taken from glucotoxicity, lipotoxicity, and inflammation, essentially “burning out”, leaving a deficiency of insulin and an increase in blood glucose (also known as diabetes).”

Which is why, having been diagnosed with diabetes a year ago, and embracing a “paleo” diet, I was able to control my blood sugars and save my pancreas from further thrashing by the insulin-carbohydrate cycle.

In short? Read the book. It’ll change your perception on what’s healthy, and enlighten you to the host of problems associated not only with wheat, but the gluten in wheat, and other “healthy whole grains” (from celiac disease to diabetes, arthritis to addiction). Grains, by the way, turn out to be about the worst things we can consume for our health (despite what the agricultural lobby…I mean Canada Food Guide…tells you).

The “heart healthy” sign on the honey nut cheerios? It’s like putting a “now with less tar” sticker on a carton of cigarettes and calling it a health product.