Diabetes

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.

 

I’m 38.7% of the way there.

Statistically, I should live to 82.5.

Nothing sobers you up faster than checking out your best before date using an online calculator. Except, perhaps, doing the math on how much of that life you’ve currently used up. Almost 39%, in my case.

It leaves me approximately 18,250 days in which to get ‘er done. Whatever ‘er’ is.

18,250 days to either work or play. Or do a bit of both, or neither.

It gives me 438,000 hours to watch my kids take their first steps, fall off their bikes, complete their first week at summer day camp. Four hundred and thirty eight thousand hours seems like a lot. It’s not. I just wasted one of them on Facebook.

This wasn’t an exercise in trying to scare myself, or give me anxiety about death. Let’s face it, any one of us could be hit by a bus or struck by lightning tomorrow. (Speaking of lightning, we had a pretty close encounter a few nights ago in a campground in Banff. A bolt of lightning struck about 50 feet from our campsite. The thunder sounded like it was inside the trailer. Fireball + smoke. Pretty wild.)

An exercise like this helps you prioritize. Focus. Be present. If I only have 438,000 hours (and while we’re doing the math, I only have 157,680 hours with my kids until they’re 18. Minus sleeping hours. Minus the 40hrs/week that I’m working.) then I better be fully present in those hours. Not thinking about the hours that have passed, wishing I’d done something else with them. Not forecasting what future hours might bring.

Being fully present, day to day, hour to hour, minute to minute. That’s the key to getting the most out of the 61.3% of my life that I’ve yet to live.

Which is maybe why I’ve been a little inactive here on the blog. I’ve been pursuing those projects and things that most closely align with my priority in life (outside of my family). That priority is helping people change for the better, and putting my diabetes diagnosis to good use.

I’m doing that in a couple of different ways right now.

First, I’m doing a little blogging (along with some workshops and soon, an online course) over here.

Second, I’m trying to reach more people more efficiently through the use of webinars, like this one. Webinars are slick, if you haven’t taken part in one. Like going to a live workshop, only often free and you can go in your pajamas, from your couch. What’s not to love?

I encourage you to go and check out your life expectancy sometime. You never know, it just might inspire you to stop reading so many blog posts and get out for a walk.

 

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.

Paleo update

As most of you know, I was diagnosed with diabetes a few years ago (2). Since then I’ve embraced the “paleo” diet (which includes being wheat free), which I’ve written a little bit about here and there. I figured it was time for a bit of an update on that adventure.

Remember the A1C? It’s a blood test that measures your average blood sugar level from the previous 3-months. When I was first diagnosed, it was 11.0 (it should be under 6.0). This time around it came in at 5.8, which is consistent with the last test. Good news.

Next up: the Lipids (aka, Cholesterol).

Triglycerides, down from 0.74 to 0.69 (reference range is from 0.60-2.30). So that’s a pretty great result.

HDL (High-Density Lipid, the “good cholesterol”): Up to 2.20 from 1.88. Anything over 1.55 is considered optimal for protection against strokes and heart attacks.

LDL (Low-Density Lipid, the “bad cholesterol”): Holding steady at 2.51 (well within the reference range of 2.00-3.40). The doctor is hoping it comes down a bit, but given the high HDL numbers she’s not too concerned.

HDL Cholesterol Ratio: 2.3. Anything 3.4 and below is considered “very low risk” when it comes to a coronary event. That’s probably good news.

All in all, it appears that eating pounds of bacon has done wonders for my cardiovascular health!

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.

Paleo Baby

So I promised my wife that I wouldn’t post pictures of our child on the blog. There are numerous reasons why, including (but not limited to), the fact that he has no choice in the matter, the internet is a permanent record and privacy is a big deal. We still struggle a bit with facebook, but the fact that grandma’s and great-grandma’s can keep tabs on his development is pretty cool.

None of that relates to the topic of the post (but does explain why a post titled “paleo baby” has no pictures of an actual baby). What the hell do you feed a baby, when you’ve sworn off things like wheat and corn? Imagine, childhood without cheerios!

Well, his very first solid food was avocado. And he was pretty stoked on it. Anyone ever read Avocado Baby? Turns out it’s pretty accurate, although our 10 month old is definitely not lifting weights (yet!).

I was cruising through Shopper’s the other day and decided to check out some of the baby “foods”. The first thing I spotted was Nestle Gerber Baby “mixed grain cereal”. Here’s a shot of the nutritional information and the ingredient list.

Now that you’re all familiar with Wheat Belly…anything wrong with this picture? First of all, check out the serving size: 28 grams. 5 Tablespoons. For a little comparison, that’s the same sugar content (8g) as a 30g serving of 70% dark Lindt chocolate. But the chocolate’s actually better for you, because the carb content is lower, and fats are higher.  I’m not advocating that you feed your baby chocolate (please don’t!). It’s just interesting.

Something else that’s interesting is the reaction that people are having to the notion of eliminating grains from their diet. Some people are well on their way, others are pretty resistant to the idea. For those that need a little motivation, check out this guy.

 

Back to feeding babies. Why would my wife and I knowingly feed our little guy something that’s proven to be toxic to ourselves? I was diagnosed with diabetes about a year ago (a disease whose symptoms have disappeared on a paleo diet). I saw this quote on Facebook the other day:

“Food can either be mother nature’s best form of medicine… or mankind’s slowest form of poison.”

I know which route we’re going with our little one.

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.

Sugar: the bitter truth.

Now that everyone’s enjoyed a bit of Easter feasting… it’s probably a good time to learn some more about what’s in your food; specifically high-fructose corn syrup. FOREWARNING: This video is 1.5 hrs long (but well worth it).

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.