While many of the headlines concerning opioid addiction and overdose deaths during the COVID-19 pandemic have focused on the synthetic opioid fentanyl, another laboratory-made opioid, Isotonitazene, is slowly gaining ground in the illicit drug market. Data regarding the drug is limited to law enforcement, drug users, and black-market dealers, which has caused extreme concern among federal law enforcement. Meanwhile, overdose deaths related to Isotonitazene have been slowly climbing since mid-2020.What Is Isotonitazene?Isotonitazene, or ISO, is a synthetic opioid derived from etonitazene, a potent analgesic, discovered by Swiss researchers in 1957. Etonitazene was found to be both extremely powerful and highly addictive when used in studies involving both animals and human. For this reason, it has never been made commercially available for human use. Isotonitazene is a chemical analogue for etonitazene, meaning that the chemical makeup of both drugs is very similar. However, it is considered more potent that its analogue, with research suggesting that it may be 100 times more potent than morphine.Initially available solely through dark web sources, Isotonitazene has recently gone from designer drug to a new and dangerous presence in the American drug trade. In 2020, the Drug Enforcement Administration reported that the deadly opioid began turning up in drug seizures in the spring of 2019. Since then, samples have been found in toxicology reports for hundreds of overdose victims.Though pills are the primary form in which users obtain Isotonitazene, it can also be found in powder form. This off-white or yellow powder is cut into other drugs by black market sources to increase potency or to create a replica of existing drugs. For example, in Canada, it has been discovered in pills manufactured to resemble Dilaudid (hydromorphone).Is ISO the New Fentanyl?While Isotonitazene is not fueling an overdose epidemic to the same degree as fentanyl, it could certainly present a similar threat if its use continues to spread through the illicit market. For the time being, it's still new to the American illegal drug market and relatively unknown to most law enforcement agencies and traffickers. While that may impede its growth in the short term, the greater concern is that dealers may use the opioid when manufacturing other drugs, resulting in a dramatic increase in opioid deaths. Law enforcement first became aware of Isotonitazene's presence in the U.S. through overdose fatalities, with substance abusers in Illinois and Indiana dying after using cocaine that had been laced with ISO.It's also difficult to know if ISO is on par with fentanyl because most toxicology reports don't test for its presence in overdose cases. It's possible that some overdose deaths linked to heroin or fentanyl may have actually resulted from ISO’s presence within those drugs. Toxicology lab reporting varies on a county-by-county basis, so a coordinated effort to track the spread of the drug must be prioritized by law and health officials in the immediate future.What we do know at this point is that deaths from ISO appear to be on the rise. Statistics revealed that six people died from overdose every month during the summer of 2019. Flash-forward a year, and the number is 50 to 60 deaths per month in the summer of 2020 – a ten-fold increase over the course of a single year. Sadly, those numbers may actually be higher, as we still don't have an accurate picture of ISO overdoses due to limited test screenings.ISO and COVID-19Statistics regarding opioid use and overdoses during the COVID-19 pandemic have already painted a grim picture of the toll taken by the drugs. Isolation, anxiety, job loss, and financial insecurity that came with lockdown protocols only served to magnify the disastrous opioid epidemic. The mental health burdens imposed by COVID-19 have sent many former drug users back to opioids as a short-term coping strategy to reduce the strain of emotional pain and external stress. ISO only further complicates matters by adding an unknown and dangerous variable to an already untenable situation. Some users may find that their drugs of choice from the past are either too strong for them, or, as in the case with ISO, cut with a powerful opioid that could prove fatal upon ingestion.Further adding to the concern regarding opioid use during COVID is the impact that these drugs have on lung health. Opiates depress the central nervous system, which causes slowed breathing. A person who contracts COVID and uses opioids may be more likely to develop serious complications, which could escalate to fatal levels with the introduction of ISO into their weakened system. There is no current data confirming that this is the case in regard to ISO overdose deaths, which further underscores the need for increased research.How to Prevent Isotonitazne Overdose/TreatmentCombating the rise of ISO amidst the opioid epidemic requires increased strategies for both prevention and treatment. Adding ISO to the Drug Enforcement Agency's list of controlled substances in 2021 was an important first step. The drug is currently listed as a Schedule 1 substance alongside heroin, LSD, peyote, and marijuana, which allows for tighter regulation and stricter legal penalties for traffickers and dealers. The next logical step would be to add ISO to toxicology tests to better understand the extent of the problem in the U.S.Continued expansion of access to the overdose reversal drug Narcan is also an effective response to rising ISO use. Increased use of the opioid antagonist to combat opioid-related overdoses has been a continued part of the public health response and it should be part of the strategy to fight ISO, as well. This is particularly important considering reports from law enforcement that several doses of Narcan may be necessary in ISO overdoses.Finally, a more comprehensive approach to treatment is needed in response to the opioid epidemic. A medically assisted detoxification program, such as Waismann Method® Opioid Treatment Specialists, allows individuals to detox in a private room of an accredited hospital while under the supervision of a specialized medical team. Medical opioid detoxification is safer, has a greater success rate, and avoids the pain of "cold turkey" approaches to detox at non-medical facilities.Inpatient medically-assisted detox followed by a supportive recovery care environment can greatly help individuals regain the strength, both physical and emotional, to break free of opioid addiction. By treating the underlying mental health problems – depression, anxiety, and trauma – that drive addictive behavior, individuals can get the relief that they need. Without access to effective medically assisted treatment programs, those suffering from substance misuse remain vulnerable to overdose from ISO and other synthetic opioids.
Once the choice is made to seek help for substance abuse issues, the question that many in recovery face is: how do I fill the time I used to devote to getting high? Choosing activities that are enjoyable and rewarding as well as beneficial to recovery can bring up a number of feelings for those new to recovery. What substance-free activities are available to me? Am I going to spend recovery in isolation, afraid to interact with others? Most importantly: is something fun if it also doesn't involve a substance?Learning to have fun and be active in recovery is a learning process. Finding satisfying activities in sobriety requires the recovering individual to put themselves in situations that might feel uncomfortable or even challenging – at first. Over time, they may find that risking discomfort is worth the effort, especially if the payoff is positive, engaging, and connective fun with other sober individuals.Five Reasons Why Sober Activities Are Good for Recovery1. Connection Is Important for Sober LivingThe isolation that comes with acting out is the atmosphere that allows addiction and all of its associated emotions – shame, guilt, frustration, despair – to take root and thrive. Connecting with others, whether friends, family, or acquaintances, takes us out of that spiral of negative emotion and into an environment that fosters community, friendship, and support – all of which are at the core of recovery.2. Activities Reduce StressIn addiction, stress is the fuel that ignites our desire to act out. Activities reduce stress in two ways: physical activity releases endorphins to the brain and boosts circulation, both of which are major stress reducers for the body. The social aspect of activities also cuts back many of the feelings that come with stress: a sense of being overwhelmed, of futility, and lack of capability. Being with others gives us natural support and makes us feel like we have resources to face challenges.3. Activities Improve HealthEveryone knows that exercise is one of the keys to good health. But even casual activity can open up a wealth of benefits for us in recovery. Sleep – one of the most consistent casualties during addictions – is improved by physical activity, as is mood thanks to the endorphins released during activity. Your immune system also gets a boost from activity – the Office of Disease Prevention and Health notes that regular activity protects you from many serious health issues, including heart diseases, diabetes, and depression.4. Activities Boost Mental and Physical EnergyBoth active addiction and recovery can sap energy and leave you feeling exhausted and enervated in both body and mind. Activity expends energy, for sure – but those endorphins it releases also give you the strength to go farther, do more, and last longer. It also clears the mind of mental clutter, allowing you to think clearly and see things as they are, not with the fog of emotions associated with addiction.5. Activities Can Help Prevent RelapseMost importantly, activity can help prevent relapse. Numerous studies have shown a connection between exercise, abstinence, and substance use, including one from the University of Southern Denmark which asked 38 people with substance abuse issues to participate in group activities three times a week for a period of two to six months. Of the twenty people that completed the program, ten reported decreased substance use and five noted total abstinence one year later.Seven Sober, Fun Activities1. SportsYou don't have to be a hardcore jock to enjoy team sports. There are local leagues for every level of expertise. And if you'd rather watch than play, every city and town offers professional, minor league, and amateur teams.2. TravelAddiction cuts off our desire to see and experience new things. Travel opens up the world to us in the most literal of ways. Getting away doesn't have to mean expensive: day trips open up our worlds to the wonder of places around us that we might have missed during our active addiction.3. EducationWe may have felt stunted intellectually during addiction – unwilling to expand our horizons, and unsure that we could ever improve our situations. Diving back into education shows us that there's never an expiration date for self-improvement. Local colleges and universities offer both in-person and online classes, as do community and adult education centers. Strapped for budget? Your local library has material on every subject imaginable, and it's all free.4. Get outsideJust as we put up defenses from travel while using, we also kept ourselves from enjoying the world outside our front door. Indulge your curiosity, get exercise, and interact with your environment by going for a walk or hike, exploring your city, town, or neighborhood, or just spend time outside looking at the stars.5. EntertainEntertaining doesn’t have to mean a lavish dinner party. Get-togethers can be simple events that hinge on a TV watch party or big game, a holiday, or even just a chance to catch up with new and old friends. The point is to underscore the fact that you can have fun with other people and still stay sober.The possibilities are limited only by your imagination. Think of what you would add to your own list of sober and fun activities, and then go out and do them! Find out more about luxury residential addiction treatment at Tarzana Recovery Centers.
Where does hedonism end and endurance begin? That was the question that rose to the surface of the excitingly murky book I was writing, Everything Harder Than Everyone Else. A follow-up to my addiction memoir, Woman of Substances, this new book looked at some of the key drivers of addictive behavior—impulsivity, agitation, a death wish desire to drive the body into the ground—and the ways in which some people channeled them into extreme pursuits.I interviewed a bare-knuckle boxer, a deathmatch wrestler, a flesh-hook suspension artist, a porn star-turned-MMA fighter, and more; all of them what I came to term “natural-born leg-jigglers.” Some copped to having been diagnosed with ADHD, and many had a history of trauma, but I wasn’t interested in pathologizing people. I wanted to celebrate the extreme measures they’d gone to, to quiet what ultra-runner Charlie Engle called “squirrels in the brain.”Personally, I have a strong aversion to running. With combat sports—my preferred punishment—you smash through stray thoughts before they have time to take root. With running, there’s no escaping the infernal looping of your mind. Your circular breathing becomes a backing track for your horrible mantras, whether they are as blandly tedious as, you could stop, you could stop. you could stop, or something more castigating. No wonder runners’ bodies look like anxiety made flesh. No wonder their faces have the jittery eyes of whippets.So when Charlie, whose running feats have been made him an outlier in the sport, told me, “I myself don’t like it as much as you might think,” I was pretty intrigued.When we spoke for the book, Charlie was bustling around his kitchen in Raleigh, North Carolina, reheating his coffee. It’s a fair guess to say he’s the sort of guy who’d have to reheat his coffee a lot.As the story goes, he was eleven years old when he swung himself into a boxcar on a moving freight train, to experience escapism. So began a life of running that no destination could ever satisfy.Charlie, who’s now fifty-nine, said something about validation early in our conversation that I wound up repeating to everyone I interviewed after him, to watch them nod in recognition. We’d been talking about his crack years, before he pledged his life to endurance races—the six-day benders in which he’d wind up in strange motel rooms with well-appointed women from bad neighborhoods, and smoke until he came to with his wallet missing.“Part of ultrarunning is a desire to be different,” he told me. “And for the drug addict, too, there is a deep need to separate ourselves from the crowd. Street people would tell me, ‘You could smoke more crack than anybody I’ve ever seen,’ and there was a weird, ‘Yeah, that’s right!’ There’s still a part of me that wants to be validated through doing things that other people can’t.”Charlie has completed some of the world’s most inhospitable races. At 56, he ran 27 hours straight to celebrate his 27 years of sobriety. If his biggest fear is being “average, at best,” then he’s moving mountains to avoid it.It helps that he’s goal-oriented in the extreme. In fact, you might call him a high achiever. Even in his drug-bingeing years, which culminated in his car being shot at by dealers, Charlie was the top salesman at the fitness club where he worked.When he began using drugs—before he’d even hit his teens—they distracted him from his antsiness. He’s noticed a similar restlessness in endurance athletes that comes from a fear of missing out. If there’s a race he doesn’t take part in, he tortures himself that it was surely the best ever. He took control of this fear by starting to plan his own expeditions, which couldn’t be topped.“I need the physical release of running and the burning off of extra fuel,” he said. “I am that guy with a ball for every space on the roulette wheel. When I start running, all the balls are bouncing and making that chaotic clattering noise. Three or four miles into the run, they all find their slot.”Even before he quit drugs, Charlie ran. He ran to prove to himself he could. He ran to shake off the day. He ran as a punishment of sorts. He craved depletion. “Running was a convenient and reliable way to purge. I felt badly about my behavior, even if very often my behavior didn’t technically hurt anybody else.”A common hypothesis is that former drug users who hurl themselves into sport are trading one addiction for another. Maybe so—both pursuits activate the same reward pathways, and when a person gives up one dopaminergic behavior, such as taking drugs, they are likely to seek stimulation elsewhere. In the clinical field, it’s known as cross-addiction.Some people in my book with histories of addiction wound up doing combat sports or bodybuilding, but it’s long-distance running that seems to be the most prevalent lifestyle swap. High-wire memoirs about this switch include Charlie’s Running Man; Mishka Shubaly’s The Long Run; Rich Roll’s Finding Ultra; Catra Corbett’s Reborn on the Run; and Caleb Daniloff’s Running Ransom Road.Perhaps it’s the singularity of the experience: the solitary pursuit of a goal, the intoxicating feeling of being an outlier, the meditative quality of the rhythmic movement, the adrenaline rush of triumph; and on the flipside, the self-flagellation that might last as long as a three-day bender. The long-term effects of running can shorten the lifespan, and there have been fatalities mid-race, but they’re tempered by the “runner’s high.” As well as endorphins and serotonin, there’s a boost in anandamide, an endocannabinoid named for the Sanskrit word ananda, meaning “bliss.”Another commonality in endurance racing is hallucinating. This, combined with runners under stress being forced to drill down to the very essence of self, reminds me of the ego death that psychedelic pilgrims pursue, in order that the shell of our constructed identity might fall away.For Charlie, part of the attraction is the pursuit of novelty and the chasing of firsts, even though he knows by now that the intensity of that initial high can never be replicated. That explains why he takes such pleasure in the planning of his expeditions. “The absolute best I ever felt in relation to drugs was actually the acquisition of the drug … the idea of what it can be,” he told me. “Once the binge starts, it’s all downhill from there. In a way, running is the same because there’s this weird idea that you’re going to enter a hundred-miler and this time it’s not gonna hurt so much...”To run an ultra takes a real dedication to suffering. Races have names such as Triple Brutal Extreme Triathlon and Hurt 100. In his book The Rise of the Ultra Runners, Adharanand Finn writes about the hellscapes in race marketing materials that appear irresistible to this breed. “The runners look more like survivors of some near-apocalyptic disaster than sportsmen and women,” he wrote. “It is telling that these are the images they choose to advertise the race. People want to experience this despair, they want to get this close to their own self-destruction.”I think about a transcontinental US odyssey that Charlie planned, in which he would run 18 hours a day for six weeks. At one point, as he was icing his ankle and beating himself up for losing sensation in his toes, one of the film crew asked him, “Do you consider yourself a compassionate person?”Charlie looked up. “Yeah. I try to be.”“Do you feel any compassion at all for yourself?”Perhaps the psychology of ultrarunners is uncomplicated: they simply prioritize the goal above the body. The meat cage is a mule to be driven, and is viewed dispassionately, whether that be for practical purposes, or from lack of self-regard, or a bit of both.“Balance is overrated,” Charlie assured—and that’s something he says when giving keynotes to alpha types. “Very few people who’ve actually accomplished anything big, like writing a book or running a marathon or whatever it is, have balance in their lives. If you’re not obsessed with it, then why are you doing it? I don’t even understand how someone can do it just a little bit, whatever it is.”When he first quit drugs, Charlie felt like taking a knife and surgically removing the addict, so strong was his rejection of that part of his identity. It took three years to figure out that the “addict self” had plenty to offer: tenacity, ingenuity, problem-solving, and stamina. Perfect for the all-or-nothing world of endurance.Excerpted from Everything Harder Than Everyone Else: Why Some of Us Push Ourselves to Extremes by Jenny Valentish. Available from Amazon, Barnes & Noble, and Bookshop.org.
Have you ever made a small social snafu, only to become obsessed with how bad it made you look? Maybe it was a silly comment, which then convinced you that everyone thinks you’re stupid. In fact, they probably left the party early because of your social ineptitude.Reading this may make it sound ridiculous, but it’s a spiral that most of us have experienced at one time or another. There’s actually a name for this type of cycle: cognitive distortion."A cognitive distortion is any system of thinking which creates a discrepancy between objective reality and subjective reality in a way that leads to undue suffering around a grief or traumatic experience,” Ionatan Waisgluss writes for Sunshine Coast Health Centre.Cognitive distortions can happen to anyone. In fact, research shows that they’re becoming more common. They’re especially prevalent in people who struggle with depression and addiction. Knowing how to recognize cognitive distortions and interrupt them can help you change negative thought patterns and keep from being sucked into a negative spiral.Types of Cognitive DistortionsCognitive distortions were first named by Aaron Temkin Beck, a psychiatrist at University of Pennsylvania. Beck developed cognitive therapy, which is now known as cognitive behavioral therapy, or CBT, one of the most common and versatile types of therapy.CBT works by identifying and interrupting negative thought patterns. But before that could happen, Beck needed to know exactly the cognitive distortions he was looking for. He identified seven main types of cognitive distortions:Selective abstraction: This happens when you fixate on a small issue, ignoring the broader context. For example, you ruminate on a joke you made that fell flat, without acknowledging that the rest of the party you threw was a success.Overgeneralization: This happens when you take a rare instance, and think that it’s universal. Overgeneralizations involve words like “always, never, everyone and nobody.” For example, you might think that nobody ever thinks you’re funny, just because one joke fell flat.Inexact labeling: No one likes being labelled, but we tend to do it to ourselves ruthlessly. Inexact labeling occurs when we slap ourselves with a negative label like “addict,” “failure” or “alone,” without considering the truth of that or the deeper context of the situation.Personalization: Personalization happens when we take random events as if they’re personal attacks. A classic example is being angry or frustrated when it rains on your vacation, even though you know objectively that the weather has nothing to do with you.Arbitrary interpretation: Arbitrary interpretation is when you decide something, despite contradictory evidence. This is sometimes called arbitrary inference, and it’s especially prevalent in people with depression. You might suddenly decide that a friend is mad at you, despite the fact that they continue to text; or think that your boss is disappointed in your work, despite continuing to get new projects.Magnification and minimization: These cognitive distortions happen when you fail to recognize the importance of a situation. They can go either way: some people make a big deal out of nothing (magnification) while others brush off major events (minimization). This can leave you unable to respond appropriately.Absolute or dichotomous thinking: This happens when you lose sight of the middle ground, and believe that everything must be one way or the opposite. You might think of people as good or bad; in recovery or addicted; healthy or unhealthy, without recognizing the nuances in people’s lives. Overcoming Cognitive DistortionsBeing aware of cognitive distortions and which you are prone to can help you break the cycle of negative thinking. This sounds simple, but it can be very difficult, since cognitive distortions feel like logical conclusions to the person experiencing them. Luckily, recognizing them can get easier with time and practice.CBT takes aim directly at cognitive distortions. First, you’ll work with a therapist to learn how to identify when you’re experiencing a cognitive distortion. Once you know that’s happening, you’re able to challenge the distortion, and provide yourself with evidence to the contrary. Ultimately, this can help you replace negative, distorted thinking with more realistic and often more positive thoughts.Cognitive distortions take away your control over your thinking, and ultimately undermine your health and wellbeing. Once you realize the impact that these distortions have on you, you can retrain your brain to look at a situation logically. Rather than being sent into a negative spiral from one socially awkward moment, you’ll learn to just shrug it off and accept all the good things that are present in your life.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
“Please smoke responsibly.” When was the last time you saw an advertisement requesting that? Most likely never. The vast majority of people know cigarettes are nothing more glorious than ‘cancer sticks’ and public perceptions around smoking have changed radically since the 1980s, when the habit was at its most popular. Nowadays, smoking is seen as anti-social and is facing ever-increasing restrictions in public places including outdoors, lest it forces others to passively inhale.Interestingly, during lockdown the downward trend of smoking reversed temporarily amongst the younger demographic, but overall more people ceased smoking than was anticipated. Starting is easy, stopping is not. I only found the motivation to stop three months before I set out to walk across America. My last cigarette, ironically, was supplied by a very good friend of mine herself dying of lung cancer aged 51. Those warnings they blazon on the ubiquitous black packets here in Europe are starting to come true within my social set. Recent research indicates the stark warnings on cigarettes only deter casual or low frequency smokers and not us hardened addicts.Britain wound up all cigarette advertising in 2002. America banned advertising on television and radio back in 1970, and on billboards in 1997. In recent years, America has largely legalised the imbibing of cannabis. When I spent six months hiking across the west coast, I was astonished to discover the childlike packaging that products are sold in. It struck me they were being sold as sweets for adults. Currently marijuana use remains illegal here in the UK but I suspect it is only a matter of time before it becomes drastically deregulated. This is going to bring questions of marketing to the fore. Will cannabis, after years in the illegal wilderness, be treated like booze or cigarettes?Currently, for women, anything over one bottle of wine a week is considered to be ‘heavy drinking’ in the UK. And yet, I am bombarded daily with advertisements for alcohol. The restrictions surrounding marketing alcoholic beverages in the UK are comparatively flimsy: they must not depict people drinking in unsafe environments, they cannot encourage excessive drinking nor claim to have health benefits. Significantly, they must not target the under 25s. Incidentally, or coincidentally perhaps, our under 25s aren’t binge drinking anywhere near as much as women in their thirties to fifties - a group whose drinking is now hitting very worrying levels indeed. Binge drinking amongst this sector of society increased 55% in the pandemic although it has been steadily rising for decades. This is directly attributed to the increase in social mobility and women gaining independent income thanks to regulation changes beginning in the 1970s. Women’s drinking is seen as also different to men’s, and thus how alcohol is marketed follows suit. Notwithstanding those gender differences, It is mandated in the UK that both static and dynamic adverts must contain the request that we “please drink responsibly”. This regulation is emphatically more polite, and less immoral, than the stark “smoking can kill you and harm your children,” which is typically stamped onto a packet of cigarettes.Marketing methods have also also changed substantially in recent years. Once upon a time sales pitches were confined to squares of various sizes in newspapers and magazines, or via moving images every fifteen to twenty minutes on a television programme. Over the run up to the Christmas period, I make a determined effort never to watch a moment’s live TV, simply so I can fast forward through the plentiful ads for seasonal booze. But in recent years the advertising bombardment has become relentless: a scroll through social media will have me assaulted every few moments. I like to soak away in the bath watching bemusing videos or documentaries but these days YouTube ads frequently interrupt my viewing. My personal algorithm seems to attract whiskey adverts, but it’s not adverse to gin either. It’s baffling to me: I’ve been sober for over five years now. Although I am largely immune to the enticements, I still have to make a concerted effort to reject some adverts as unwanted or unsuitable. Regardless, I am targeted and I can’t help but observe that the overall message is that the alcohol product will make me more sophisticated, more sexy and far more entertaining than usual. I used to believe that too. Only it didn’t, and I have ample war stories to bore my fellows in recovery with. The time I bought a jetski whilst intoxicated? Hilarious! The time I fell face-first into a wall breaking a finger and splitting my lip. Not so much. The time I abused someone I’d never met on an online forum thinking I was being funny. Absolutely cringe-inducing. Oh, but my drinking was absolutely fine, I told myself, because I only drank on so-called non-school nights and after six o’clock.Then there’s the culture of drinking. In March 2020, memes began to tackle the long-held myth that daytime drinking was the only problematic kind of drinking. All of a sudden, during the pandemic it was being normalised. “When lockdown is over, half of us will be expert bread-makers and the other half will be alcoholics,” was one that stuck with me.” Another one referred to the stringent stay-at-home orders: “Homeschooling is going well, two students have been suspended for fighting, and the teacher has been fired for drinking on the job.” Alcohol is now sold as an act of parental self-care, but substitute ‘drinking’ with ‘smoking’ and the humour is readily whipped away.One of AA’s most oft-quoted phrases is “alcohol is cunning, baffling and powerful,” and so is its advertising. Seventy percent of us are aware of the link between smoking and cancer. Less than fifteen percent of adults know that drinking and cancer strongly correlate too. In women, one bottle of wine a week is said to be the equivalent of ten cigarettes (five for men) in terms of damage done.Smokers and drinkers rely on these substances to soothe, to entertain, to displace a myriad of unpleasant emotions, or elevate good moods. There’s no doubt that they work on psychological levels, but for some of us their lethal nature is bound by the fact we have a physiological reaction not universally applicable to the population at large. We still can’t be sure whether alcoholics are born or made, there’s evidence to support both ends of the dichotomy. Cannabis is said to be non-addictive, yet recent research is exploding this myth: and just like alcohol, not every user will end up dependent. The problem arises is that we don’t currently know who will become addicted and who won’t. And for those of us that do, many of us assume we are in the camp that isn’t. What’s even more perplexing is why these two very lethal substances are treated so differently when it comes to marketing. So please: do smoke responsibly but remember that alcohol can kill you and harm your children. Person Irresponsible is the author of Everything You Ever Taught Me, which captures her six-month hike across America, sober and cigarette-free, during the pandemic of 2020. She got into the recovery gig in March 2016, stopped smoking in late 2019 and gave up walking long-distances on 7th September, 2020.Like all addicts, she knows this is just a temporary reprieve and is likely to take up something new soon enough.
Most people who have struggled with alcohol abuse can name their poison — maybe beer, or wine, or a cool gin and tonic. Even after you’re in recovery, your drink of choice might come to haunt you now and again. Few people with alcohol use disorder would name ethanol as their drug of choice, but the truth is ethanol is present in all alcohols. Here’s what you should know about ethanol, also known as EtOH, and ethanol addiction.What is ethanol?Ethanol refers to an organic chemical compound. In fact, its chemical compound — EtOH — now doubles as a slang or street name. Ethanol is produced when grains or fruits are fermented. That means whether you’re drinking a cold beer or a sophisticated merlot, the effect the drink has on you can be traced back to ethanol. Most people don’t think of ethanol as a psychoactive drug, but it produces brain changes that are positive — like relaxation — and negative, like depressing the respiratory system.Ethanol is present in all alcoholic drinks, but it is found in plenty of other places as well. In higher concentrations alcohol is used for cleaners (looking at you, hand sanitizer), polishes, cosmetic products, plastic production and much, much more. Ethanol is even found in 97% of gasoline in the United States. Although you probably haven’t thought about ethanol much, chances are you come into contact with products made with ethanol daily — even if you’ve long been sober.How is ethanol made?Since ethanol is a naturally-occurring substance, it pops up any time grains or fruits are fermented. Ethanol isn’t added to beer or wine, but it is found within them, in varying concentrations.For commercial and industrial applications, ethanol is produced by fermenting corn. When the corn is distilled, it results in a liquid that is 10-15% ethanol. This is then boiled down until almost all the water evaporates and the liquid is 95% pure ethanol. Through straining, the remaining water is removed, leaving 100% alcohol behind.Ethanol and alcoholEthanol is pure alcohol. In the alcoholic beverages that people drink, this is measured using the proof system. To calculate this, manufacturers determine how much ethanol is in the beverage: this is known as alcohol by volume (ABV). The proof of the drink is double that amount. For example, a 50 proof alcoholic beverage contains 25% pure ethanol.This becomes important for people who have alcohol use disorder. As with many substance use disorders, people who misuse alcohol often build tolerance: that is, they need more of the substance in order to feel the effects it has. At the same time, they also develop a physical dependency, meaning that their body needs an every-increasing amount of alcohol just to function normally.People who have severe alcohol use disorder might find themselves reaching for alcohol that has a higher and higher proof or ABV. In severe cases, this could culminate in people consuming ethanol or products that contain a high concentration of ethanol but are not meant for human consumption.Even if you do not drink pure ethanol, you can still experience ethanol poisoning from drinking too much alcohol. Symptoms of ethanol poisoning can include stomach pain and vomiting, confusion, slurred speech, impaired function and slowed breathing. If you abuse EtOH frequently, you’re even at risk for organ failure.Treating EtOH Treating ethanol addiction can be difficult. By the time a person developed an EtOH addiction or dependence, they are often deep into alcohol use disorder. Alcohol, particularly at high concentrations, can affect nearly every system in the body, including the liver, cardiovascular system, digestive system and nervous system. In addition, living with alcoholism can erode a person’s mental and emotional health, and damage their relationships with loved ones.That’s why it is critical to get professional treatment for EtOH addiction. Treatment providers who are experienced at treating ethanol addiction will know how to address the physical, mental and emotional impacts of this disease. A treatment program that is highly individualized can help you understand why you are prone to misusing alcohol and change your patterns.
Chapter 4: FIORINAL 2008It was hard to determine what Kevin knew about my increasing binging. He was starting to speak up, noting I can tell when you’re on them or Your personality changes. I chose not to pay attention to what he said. As long as he didn’t stand in Our way, I really didn’t care what Kevin thought, and as I pulled into the pharmacy’s parking lot, I was no longer thinking about my husband at all.Flipping down the visor mirror, I slid on a generous layer of lipgloss. I always made an effort to look nice before I saw Her. My pupils were black, glinting with Her magnetic force, goading me towards a dark dance choreographed just for Us.Clip, clip, clip. My heels echoed across the parking lot. Fiorinal empowered me. Around Her I soared, in spirit and stature, insecurities like my stunted growth from kidney disease dissolved. I had always felt awkward about my height, but in this moment, invincible—all legs and no regrets.I entered my church. The antiseptic smells of witch hazel, hemorrhoid cream and Epsom salts comforted me like Roman Catholic incense swirling around the sanctified on their knees. Here I would drink the holy water. Here I would be saved.Fiorinal and I had discovered something that made our relationship even stronger. In Vino Veritas. This was how we would really bond. We did not care for the subtleties of pear notes or a blackcurrant after taste. We were fans of what was cheap and cold. My customized cocktail was simple: the coldest possible chardonnay and a fistful of blue plastic pills. No mixologist could ever trump this winning combination. Hold the fruit, straws and tiny umbrellas. I took my absolution straight up.I grabbed a sale-priced Mondavi and pretended to peruse the label. Really I was just fondling the nape to see if it was cold enough. Almost perfect. Nothing that a few ice cubes couldn’t cure. Then I marched towards the pharmacy.STEP 2: The Purchasing of the Medication. A BOTTLENECK of customers jammed the analgesic aisle. I joined the crooked, toe-tapping line, slumping my shoulders along with the others: the plaid-clad, blue-collared workers, the disheveled, scrunchied housewives and the hopped-up hipsters. My greatest fear was to approach the counter and have the pharmacist report they were out of stock.An elderly man was rambling on about his medication regimen, then his insurance, then, could they check that his generic medication was the same as the brand name? Oh, my God. How can an old man talk so much? Shifting my weight from one foot to the next, I rested the bottle along the back of my neck. Nice and cool. I wanted to yank him by his shirt collar and hurl him into a display of One Direction singing toothbrushes. I tried to make eye contact with one of my fellow prisoners-of-wait, to commiserate in mutual irritation. Everyone was either dialed-out, heads up, scanning the water-stained ceiling tiles or dialed in, heads down, scrolling on their phones. We were nothing if not a motley crew of disconnected pill poppers.“Next!”I approached the counter. The backs of my knees quivered as the cashier retrieved Her from a hanging hook on the back wall. Thank you, God. Folding over the top of the bag, he stapled it shut. My mouth watered. She was so close now. I calmly placed the wine on the counter and offered my debit card. I smiled brightly. He ignored me.“Have you ever taken this medication before?” I wanted to laugh in his face.“Yes. Thank you.” I replied. He lifted the bag. Our eyes met. I watched as it dangled from his arm over the DMZ of the pharmacy counter. No longer his, but not quite mine. His eyes narrowed as my fingers curled around empty air. I grabbed the bag and pirouetted away, tucking the wine under my shoulder and charging through the front doors.This was the feeling I wanted every moment of every day. Like fucking Christmas morning. Like fucking on Christmas morning. In this dance of anticipation, I was about to fall into my partner’s arms and succumb to every inch of Her charms; crossing over from Hen to Her, losing myself one delicious misstep at a time.I slid into the car, tucking a damp tendril of hair around my ear. Organizing my bags on the passenger seat, I glanced up to make sure no one was around. Sometimes I wondered if anyone else was doing what I was doing. Taking their controlled medication before heading home, despite a prescription label that warned: Do not drive on this medication. Mostly, I chose not to think moments like this through, never connecting the dots between my secretive adventures and how, a few days later, I would be dope sick and full of remorse. Just like alcoholics were men in trench coats who sat on park benches and drank from bottles concealed in paper bags, drug addicts were ne’er-do-wells who lived under bridges, jamming needles into their arms slamming heroin eight times a day. I did not know that addicts, like pills, came in all shapes and sizes.The label also read, Avoid alcohol while on this medication. I chose to focus on the part that said Alcohol may intensify effect. Wasn’t that a good thing? I was prescribed this medication. It was medicine I needed.My heart slowed as I lifted Her from the bag. Ker-thunk. Ker-thunk. Oh, there She was! Her sweet white mushroom cap topped Her peach-plastic shell. Palming the lid, it popped open with a satisfying crack. The acrid smell caressed the fine hairs of my nostrils, promising what I could not deliver for myself—freedom. Excerpted from In Pillness and in Health: A Memoir by Henriette Ivanans. Available at Amazon and elsewhere.
The traditional approach to substance abuse treatment is simple: walk into a 12-step meeting, and accept that you are powerless. For decades, this approach helped many people get sober. Unfortunately, many more realized that this approach was flawed. For these people, substance use wasn’t the only problem, but rather a symptom of a core issue that they were grappling with, like abuse, mental illness or trauma.Today many treatment centers simply follow the 12-step approach. However, comprehensive treatment centers, like Oceanside Malibu, have realized that addressing clients’ core issues at the same time that substance use is treated can provide the foundation for a long recovery.Here’s what too many people get wrong about substance abuse treatment, and how a better approach can improve outcomes.Why do core issues matter?Imagine you have a stuffy, runny nose. You go to the doctor and treat yourself with antihistamines and hot showers. That helps temporarily, but when you dig around you realize that the runny nose is being caused by mold in your apartment. No matter how well you treat your symptoms, they’re always going to come back, until you address the root cause of the symptom: the mold.The same is true of addiction. Sure, many people have a biological predisposition to addiction. Some substances are more addictive than others. But the simple truth is that most people with substance use disorder have core issues that they need to address in order to make the most of their recovery.Detoxing is a great first step. In the example involving physical illness, controlling the symptoms of the runny nose might give you the energy you need to deal with the mold. The same is true for addiction — once your body is clear from substances, you are able to look at your core issues, and it's critical that you do so.What if people aren’t ready to address core issues?Sometimes, there’s hesitancy to bring up core issues. Someone in substance abuse treatment has usually admitted to themselves and their loved ones that they have a problem. Although they’re willing to admit that they drink or use too much, it can be a big leap to discuss why they’re using. In some cases, addressing core issues can mean confronting truths that you’ve never acknowledged, even to yourself.Because of that, some treatment approaches shy away from addressing core issues, arguing that people who are newly in recovery might be too fragile, or not yet ready to deal with emotional and psychological scars.Glossing over core issues can reduce the turmoil that a person feels initially, but eventually the core issues will come to the surface and strain a person’s sobriety.What we can learn from co-occurring disordersNot long ago, co-occurring mental illness and substance use disorder were addressed separately. Practitioners thought that it was best to help someone get sober, and then focus on stabilizing their mental illness.Unsurprisingly, the untreated mental illness often made it hard for people to stay on track with their sobriety. Now, researchers acknowledge that an integrated treatment approach is best. People with co-occurring disorders receive addiction treatment at the same time that they get mental health treatment. This has vastly improved outcomes.Even people without a co-occurring mental health condition can learn from this: in order to stay sober long term, we need to address the issues that make us turn to drugs and alcohol, consciously or unconsciously.A multidisciplinary approachGetting to the crux of your core issues isn’t easy. However, a treatment center that provides a holistic, individualized approach to treatment can help you identify the reasons that you are prone to substance misuse, and deal with those issues head-on. Whether you have anxiety, trauma or the buildup of adverse childhood experiences, learning healthier coping mechanisms can set you up for success in recovery.Learn more about Oceanside Malibu at http://oceansidemalibu.com/. Reach Oceanside Malibu by phone at (866) 738-6550. Find Oceanside Malibu on Facebook.
Consider your family tree. Can you see places where it is bent or broken? Perhaps you can see where the scars on the tree have changed the direction that the limb grew.The tree analogy is apt when we consider the ways that trauma can be passed from generation to generation. Trauma is the result of an overwhelming undigested experience, according to Sunshine Coast Health Centre, a non 12-step rehab program in British Columbia. In much the same way that trauma can manifest for an individual, it can be passed from one generation to the next.Both addiction and mental illness have a genetic component, but they also run through families due to intergenerational traumas, which can increase the risk for substance misuse or mental health disorders. Understanding the real role of intergenerational trauma can help you heal yourself, and break the cycle, creating healthier patterns for future generations.What is intergenerational trauma?Intergenerational trauma is inherited trauma. The theory specifically focuses on the way that trauma can be passed through genes. Some research indicates that living through a trauma can change the way that genes are expressed in future generations. Trauma can’t change your DNA, but it can change the way that the genes you have are expressed. This is known as epigenetics, or the way that the environment changes the way your genes manifest.Some of the first research on intergenerational trauma was done on the families of Holocaust survivors. Researchers found that the children of survivors had increased risk for a variety of behaviors, including anxiety and nightmares.Since then, researchers have studied other groups and found that the effects of trauma are present in their children and even grandchildren. Researchers have seen physical characteristics, like differences in the brain, that show that these behaviors have — at least in part — a biological cause, and aren’t just the result of being raised by a parent who has experienced trauma.Individual events like abuse, or widespread societal events like famine, racism and war can all spur intergenerational trauma.ACEs and traumaOf course, biology alone can’t explain the way that addiction and substance use disorder are passed through families. In addition to any epigenetic and biological approach, researchers also consider the environment in which subsequent generations are raised. For example, people raised in poverty are more likely to raise their own children in poverty; those who have been abused are more likely to abuse children. Just like a trauma history can affect our epigenetics, it can affect our learned behavior and how we parent.It can be helpful to think about exposure to Adverse Childhood Experience, or ACEs. ACEs are traumatic events that occur before the age of 18. ACEs include:Living with someone with mental illnessEconomic hardshipBeing abused or witnessing abuse, of oneself or someone elseHaving a parent with substance use disorderParents that divorceHaving a parent in jailPeople who have four or more ACEs are more likely to have substance use disorder, drinking problems, and other physical and mental health conditions. This risk may compound existing risk that a person has due to genetics and epigenetics, making it more likely that trauma will be passed through generations.Breaking the cycleTrauma is powerful — but not all-powerful. It is possible to break the cycle of intergenerational trauma. One of the most critical steps is getting treatment for your own substance use or mental health conditions.Building resilience in yourself and in the next generation can offer protection against the effects of ACEs and help break the cycle of intergenerational trauma. Researchers have identified seven ways to build resilience in children, by focusing on:Competence: Building their skillsConfidence: Teaching them to believe in themselvesConnection: Growing strong, nurturing relationshipsCharacter: Teaching them right versus wrongContribution: Helping them be of serviceCoping: Teaching healthy skills for responding to stressControl: Giving children autonomyMany of these mirror the skill set that a quality treatment center provides. Part of overcoming substance use disorder involves building resilience in yourself. Not only will that help you, but it can help you children and even grandchildren.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
The tumultuous events of the last year – political unrest, the coronavirus, and even the 20th anniversary of the terrorist attacks on September 11, 2001 – have put our first responders and public health workers in sharp focus. Federal, state, and local law enforcement, as well as firefighters, and emergency medical services (EMS) face extraordinary challenges on a daily basis: they are regularly the first on the scene during or after a crisis, and the first to offer support and protection to the injured, survivors, and onlookers. Though first responders are trained to work efficiently under the most challenging conditions, the constant exposure to life-threatening or traumatizing events will eventually take its toll.A 2018 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) noted that an estimate 30 percent of first responders develop mental health conditions, including depression and posttraumatic stress disorder (PTSD). For civilians, the rate is 20 percent. The report cited another study that found that the suicide rate among law enforcement is an estimated 125 to 300 police officers per year. The suicide rate among firefighter and EMS is equally troubling: a study of more than 1,000 current and retired fire personnel found that 15.5 percent attempted suicide (the civilian rate is 4.6), while another report found that 6.6 percent of EMS professionals reported attempting suicide (the report's civilian rate was 0.5 percent).Substance abuse, including alcohol and narcotics use, can also be high among career first responders. Fifty percent of male firefighters and 39.5 percent of female firefighters reported heavy or binge alcohol drinking in a single month. A study looking into alcohol use among police officers following the events of Hurricane Katrina in 2005 found a "significant association" between relief efforts for that natural disaster and hazardous alcohol drinking. Another study of police officers after Katrina found that their average number of drinks per day after the hurricane increased from two to seven per day.First responders also face a host of factors that impact them in ways that differ from how the general population experiences traumatic events. Additionally, they face collateral behavioral health damage before, during, and after disasters. First responders may have their hands full with mental or physical issues before they arrive at a traumatic scene; according to the SAMHSA report, these may include on-the-job problems, such as inadequate training, excessive expectations from superiors, issues of favoritism, fatigue, and lack of time off. When combined with issues outside of the workplace – depression, anxiety, physical health problems, family problems, personal loss – and those particular to their line of work, such as regular exposure to death and severe injuries, all contributed to increases in PTSD, substance issue problems, anxiety, and depression.So how can first responders gain the support they need in the face of such challenges? The SAMHSA report had a number of suggestions: leaders can assist by developing clear strategies for dealing with disasters that include all team members and foster cooperation within the organization. They can also inform team members that the situation they are facing has the potential to generate stress, and encourage them to speak candidly about their ability to perform under such conditions. They can also take notice of team members that appear to be fatigued or suffering from psychological issues, and make plans for all team members to take part in self-care during the actual disaster situation.Unfortunately, many first responders feel that asking for help is not part of their emotional makeup. In an interview with the Reno, Nevada-based television station KOLO, James Brumfield, president of the Truckee Meadows Firefighter Foundation, underscored the reluctance that many first responders feel in regard to their emotions. "By nature, we want to be there to help people," he noted. "And we're going to be the last to speak up when something is bothering us."For clinician Steve Nicholas, who is embedded with Truckee Meadows Fire and Rescue, that belief is not only outdated, but also dangerous. "The [idea] of the warrior never hurts, well, that's silly," he said. Problems arise for many first responders when they leave the disaster situation. "It's when they go home," said Nicholas. "And they're not necessarily in that mindset – the stack of three cereal bowls in the sink will be the tip-over moment."Brumfield agreed. "It's the quiet, self-reflection time where it seems like some of the darkest moments get re-lived again."When those darkest moments prove too overwhelming for first responders, there are mental health options that are available to them that specifically focus on their needs. Wish Recovery – luxury rehab & detox, a private dual diagnosis residential detox and alcohol/drug treatment center located in Northridge, California, has addiction treatments and therapies tailored specifically to first responders, who recover alongside members of their peer group.The facility's team includes both current and former first responders with extensive, first-hand experience with and clinical knowledge of the mental, emotional and physical stressors faced by first responders on the job. Through group, family, and individual therapies, clients learn new, healthy ways to cope with depression, anxiety, grief, fear and work-related trauma. They also have access to an array of modalities, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), experiential therapy, EMDR and trauma-based therapy, and relapse-prevention therapy.
"When I walked in there my eyes went straight to that table in the corner where they were sitting. I remembered that stupid candle and the way they were looking at each other so intently--it was like they were eye fucking.”Passenger Melody* was referring to a once beloved Silverlake bar at which she'd seen her ex on a date with another girl two years prior (after two of them had only been broken up for a week).Since then, every time she entered her body would tense up and she’d go into shut-down mode. She remembers how alone she felt afterwards--unable to make conversation, disconnected from the group she was with."The laughs and shouts of everyone around me felt maniacal, and the bro spilling beer on my shirt as he passed by felt intentional. I tried going back to the bar again after that but my body just steeled itself. I can’t for now.”Talking to Melody reminded me of the powerful associations that certain places can carry. Memories get stored inside our unconscious, sometimes forgotten by our conscious minds. Years later, the slightest smell, sound, or touch can convoke them.I’m reminded of this each time I climb Magnolia Avenue, the curvy street I used to ascend to get to school as a teen. All of a sudden fuzzy headphones are covering my ears, my disc-man jostles around in my gym bag (the track sometimes skipping), Megan Frock’s* cat shimmies around overturned cleats on the front porch of her tangerine colored house. I'm back in my high school body.These conjured memories aren’t always so welcome or benign. As you could tell from the opening quote, Melody’s were more negative and prevented her from wanting to re-enter the place. I definitely related, as for a while I too had to avoid certain places in my college town that carried too many painful associations.Driving past a freeway exit that bore the same name as my college ex’s new “friends with benefits” on the way back to Davis from my parents’ house in Oakland, for example, always evoked the same visceral reaction that overtakes me when my cars' tires pass over a dead animal.For a while I also didn't want to go back to the brewery where another ex girlfriend and I had our first heated conflict.Bad things don’t even need to have happened inside the triggering place. Even having been merely thinking of something negative, or going through a rough time when you were last there, can be enough to resurrect those same feelings the next time you step foot into the place.When I walked in to certain spaces, I’d instantly feel depressed. I always tried to CBT my way out of it, but these undeniable black drapes hung from every wall. Negative emotional energy left by memories still circulated the air.A former client of mine once said: “I studied in a specific cafe—usually my happy place, filled with plants and murals and LA sun streaming through— every day when my mom was fighting cancer. I tried to take in information about organic compounds and hydrogen bonds, but instead what filled my mind were images of her in bed, the pain on my dad’s and sister’s faces, thoughts of life without her. I can’t go back there anymore. The place is tainted. It will always be filled with memories of memories that are just too painful to revisit.”It’s not even necessary to have spent time with a person who triggers painful emotions while inside the place in question. Even just thinking about them the last time you were there is enough to summon memories and unlock old painful feelings."Your memory of a thought is married to the place in which it first occurred to you," writes Jennifer Ackerman, author of The Bird Way.~~What I’ve found helps is that if I’ve been experiencing a hard time at the same time that I’ve been going to a certain store, or taking a particular road, I will sometimes avoid that place--not for forever, but at least until the wounds are less fresh. Or until enough time has passed for the negative associations to clear out.Passenger Trey* stayed away from a Hollywood Hills hiking trail that he used to run at often when his dad was dying. If he were to keep going back to it before he had healed, the negative feelings and associations would just continue to compound upon one another. His mind might permanently categorize it as a negative place—“and I don’t want that to happen because it’s a kickass place and I love it; the hills are rad and I can get a really amazing workout, am always sweating by the time I’m done.”In Melody’s case, after she stayed out of the bar for a year, when she finally did go back, it no longer had power over her. You might think of it as temporary avoidance— a strategic and proactive (rather than reactive) move. I want this place to go back to doing what it once did for me, so I’m gonna give it some space. What's more, putting yourself in new surroundings gives your mind novel details to pay attention to, which is great for preventing rumination.There’s catharsis in breaking free from negative past associations. And once we take that temporary break, we can watch as positive associations repopulate once fraught places, breathing new life into them. *Names changed to protect confidentiality
For individuals struggling with opiate dependence, detox and, subsequently, withdrawal symptoms can be the first step in gaining freedom. Successful opioid detoxification can help accomplish this goal. Rapid detox allows for a complete detoxification from opiates while the patient is under sedation. The process is also beneficial because it enables the patient to immediately start Naltrexone or Vivitrol therapy, both non-addictive drugs that significantly help reduce physical cravings after detox. Controlled studies have found that this form of detoxification is both practical and cost-effective.However, it's important to note that not all forms of detoxification under sedation are the same. Since anesthesia detox was developed in 1988, centers have adopted various protocols; some might even promise complete treatment after one day. While the idea of immediate relief from opioid dependency and the withdrawals accompanying detoxification efforts may appeal to those in the grip of addiction, such promises are not fair, accurate, and sadly enough, often not safe.The continued use of opioid drugs causes the body to become dependent. Opioid dependence leads to withdrawal symptoms, which makes it difficult to discontinue use. Once a user stops using opioids, the body goes through tremendous physical and emotional distress associated with withdrawal. Symptoms can include muscle pain and spasms, gastrointestinal distress like nausea or vomiting, depression and anxiety, fatigue, and sleeplessness. Dependence is often followed by addiction. Addiction occurs when opioid dependence interferes with daily life. Symptoms of addiction include uncontrollable cravings and the inability to control drug use regardless of the adverse effects on every aspect of one's life. Although rapid detox, sedation-assisted detox, or any other form of detoxification under anesthesia might be extremely appealing, it is not a cure for addiction and should not be described as one. Withdrawal symptoms may be too challenging and physically unsafe for a person already physically and emotionally in a fragile state, making medically supervised detoxification a more viable option. Instead, when performed responsibly, at a proper facility, by an experienced anesthesiologist, sedation-assisted detox is an excellent option for complete opioid detoxification and for reducing physical cravings. That's why Waismann Method® Opioid Treatment Specialists and Rapid Detox Center do not support one-day detox protocols. The Waismann Method team believes that patients deserve comprehensive and responsible medical care. Furthermore, opioid use leads to significant physiological changes that affect the individual on many levels. Having enough inpatient time before detox for stabilization, evaluation, and tailoring of an individualized protocol is as essential for the safety and comfort of the patient as providing inpatient recovery care for a few days after detox.In 1998, Clare Waismann RAS/SUDCC founded Waismann Method, located in Southern California. After a few years, Mrs. Waismann understood that patients deserved more. Sending them to a hotel room or home immediately after detoxification under sedation was no longer an option. In 2005, Domus Retreat was created: a safe environment where patients can start adapting to this new opioid-free state while receiving professional assistance, care, and guidance around the clock.For the last 23 years, patients have traveled from all over the world to California, where they receive treatment from a quadruple-board certified medical doctor in their private room of a full-service accredited hospital.Although most patients come for detoxification under sedation, there are several medically assisted detox options. From a clinical standpoint, opioid withdrawal is one of the most influential factors driving opioid dependence and addictive behaviors. Waismann Detox™ tailors every treatment based on the understanding of each individual's specific health needs. However, not all opioid detox treatment facilities follow the same stringent protocols as Waismann Method. To that end, Waismann and her associates suggest the following criteria when considering a rapid detox or treatment center that offers detoxification under sedation:The treating physician should be a board-certified doctor with a degree from a reputable educational institution. Board certifications are rigorous programs that require doctors to continually assess and enhance medical knowledge, professional judgment, and clinical techniques.Detox should occur at a full-service accredited hospital. A hospital allows access to medical specialists and immediate medical support with no time constraints for inpatients. This requirement is one of the most frequently overlooked by potential patients, especially those seeking lower-cost options.Patients should receive their own private ICU hospital room and individual attention from medical professionals. These are common oversights for patients, and while shared rooms and medical attention may reduce costs, they also carry the potential for greater risk during the procedure and personal discomfort.One-day and overnight detox centers can be dangerous for several reasons. Though the potential for instant cures can be appealing, it is usually not the safest option. Doctors must have the time to give patients a comprehensive inpatient evaluation and stabilization care for at least a day before the sedation-assisted detox. Before the procedure, they must also have enough information on the patient's intake – food, medication, and other substances – to avoid adverse reactions when the detox drugs are introduced to the patient's system.Post-detox patients should have access to FDA-approved medication like naltrexone and Vivitrol. They should also stay in a specialized recovery center for a few days where their mental and physical stabilization can be observed and attended to. The additional few days of care allows the patient to become more stable while reducing the risks of immediate relapse.Waismann advises that individuals considering any form of rapid detoxification conduct comprehensive research into a facility's protocols, promises, and, more importantly, physician’s credentials, experience, and affiliation with reputable organizations. It is important to know that although medically assisted detoxification can be a life-saving procedure, there are no overnight miracles; nor is there one exclusive treatment that fits every patient's unique health needs.Opioid use disorder is a multifaceted condition that needs to be treated by a team of specialists with a tailored protocol for each person. No single approach to opioid detoxification is guaranteed to work well for all patients. Therefore, detox centers should offer several options, so no patient is pushed into a procedure that does not meet their specific health needs.
Almost everyone is familiar with the sensation of sunburn. After a day of splashing and fun at the beach, you’re overexposed. Your skin is red and any tiny touch can feel overwhelming.Now, let’s consider the idea of emotional sunburn. This is how some professionals characterize Rejection Sensitive Dysphoria (RSD), a condition that often appears in people with ADD and ADHD. After years of being criticized and critiqued for their behaviors, people with these conditions often feel raw and vulnerable. Because of that, they can react strongly to any real or perceived criticism, critique or failure.What is RSD?Usually, RSD is characterized as an outsized reaction to an incident, says Mandy Schneider, alumni coordinator at Sunshine Coast Health Centre, a non 12-step drug and alcohol rehabilitation center in British Columbia. Someone with RSD might show emotional outbursts, which are sometimes confused with rapid-cycling bipolar disorder or other mental health conditions.RSD can manifest in two ways. Some people become angry. These people are prone to outbursts, and may become aggressive to themselves or others. In other cases, RSD manifests as anxiety. People with this form of RSD are likely to become withdrawn and isolated. They may become perfectionists in hopes of avoiding failure.RSD might present as aggression toward others, but the condition is even more dangerous when it is internalized. In the most severe form, this can lead to suicidal ideation.ADD/ADHD and RSD: The ConnectionUnderstanding the connection between ADD, ADHD and RSD can help people get the treatment that they need. Some estimates say that children with ADD or ADHD receive 20,000 more negative interactions during their school years than their neuro-typical peers. Constantly being told to sit down, calm down, and work differently can grate on people, particularly if they have not been diagnosed and thus don’t have a clear understanding of the root cause of their behaviors.Overtime, these people can become particularly vulnerable to having outside emotional reactions when they experience criticism. This compounds the emotional dysregulation that is a feature of ADD and ADHD in children and adults. Up to 70% of adults with ADD or ADHD have trouble controlling their emotions. RSD is an even more pronounced and severe form of this.Treatment of RSDRSD is not a well-known condition, so it can be difficult to get a diagnosis. Still, many people feel relief when they are diagnosed, in part because they learn that there is an explanation for their behaviors.Once RSD is diagnosed, providers can use medication to help alleviate the symptoms. A class of medications known as alpha agonists can provide relief to about one-third of people with RSD. MAOI inhibitors can also help control the symptoms of ADD/ADHD and RSD. Some people find that controlling the symptoms of their ADD or ADHD can make them less prone to mistakes. That might reduce the frequency of criticism that can lead to outbursts.Medications alone can’t fully control the condition, however. Cognitive behavioral therapy might allow people to better understand their triggers, and equip them with healthier coping mechanisms when they feel an RSD episode coming on. However, CBT and other therapies are considered less effective for RSD than they are for other mental health conditions, in part because of how quickly an episode of RSD can be triggered. Although therapy may be helpful, mindfulness can also help people with RSD control their emotional reactions.Spotting and Treating ADD/ADHD and RSD in AdultsIn order to get treatment for RSD, you’ll need to identify the condition as the cause of your emotional dysregulation. Getting a diagnosis of ADD or ADHD can be an important first step. Although ADD and ADHD are more common in children, an estimated 2-5% of American adults also have the conditions. Although diagnosis of ADD/ADHD in adults is on the rise, it remains relatively rare. Oftentimes, a patient must raise the issue with their provider in order to get a diagnosis.In adults, the symptoms of ADD/ADHD can include:ImpulsivenessForgetfulnessRestlessnessExtreme emotionsAdults who have RSD might:Become “people pleasers” to reduce the risk of criticismFocus on perfection to lessen the chances of failureExperience emotional reactions as physical symptomsHave intense emotional reactionsBe their own worst criticIf the symptoms above look familiar to you, you should talk with your doctor about whether you might have ADD, ADHD or RSD. It’s never too late to get a diagnosis for these conditions, and start on the path to better mental, emotional and physical health.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.
I am writing in the dark, by hand, hoping my words make sense tomorrow morning. The light of the screen hurts my head because I have a concussion.Two weeks ago, I was hit by a drunk driver while heading out to pick up my CSA box on a Thursday morning. I saw him coming toward me on the wrong side of the road at about 50 mph on my neighborhood street. I screamed “Nooo!” and waved in a desperate jazz-hands gesture just before impact, hoping he’d see me and swerve away at the last moment. He didn’t. In a split second, our cars were connected in a sickening crunch. I didn’t hit my head. No glass was broken. I was just shaken—hard. He stared into me, wild eyed, threw his car into reverse, then drove away.I exited the vehicle in an adrenaline-fueled rage, yelling expletives as I tried memorizing his license plate. A Good Samaritan came to my side and asked if I was ok. Just as she did, we heard a crash from around the corner. He had hit someone else.By the time I turned my car around and drove the block to where he was, his vehicle sat wedged into the side of a gigantic hauling & demo truck. I saw several men holding a man of about 60 who was bleeding from his head, belly distended from the bottom of his white tank top. He fought them in slow-motion until first responders arrived. “He threw a tequila bottle from the car” one neighbor told me. “He smells like alcohol” another said as he was taken away in an ambulance. I kept my distance, took my police report and drove my leaking car home, thanking the Universe the crash wasn’t any worse.After a trip to urgent care, I found the seatbelt left a bruise and I had a pinched nerve causing a tingling arm. A few days later when the right side of my head felt strange, I saw a neurologist who performed some tests. One was the Romberg test, where I was asked to stand with my feet apart, arms out and eyes closed. I found myself frustrated, normally a yogi still doing handstands into my 50s, yet here I was swaying to the right, unable to balance on my own two feet in a doctor’s office, right side up. Later research revealed that the Romberg used to diagnose my concussion is the same one sometimes used by law enforcement to determine DUI.I have my issues but have never been addicted to anything, nor had a problem with alcohol. It just never agreed with me. I am one of those annoying people who could drink occasionally in college, then not do it again for months or years. I also grew up in Washington, DC, very involved in the punk scene and heavily influenced by the idea of “straight edge.” My partner doesn’t drink and by my 30s I eventually just quit altogether, no big deal.But I have loved many addicts. Some who have left this earthly plane in the most cliche of ways. Some of whom I’ve had to let go. Some who have turned their lives around. I have benefitted from Al-Anon.This accident brought all of that to the surface. Why did this happen to me? Why was I repeatedly the one on the other end of the “making amends” step, dammit? As my anger with the driver subsided, I recognized that his drunken state at 11:30 on a Thursday morning was evidence of his own pain. I thought about all of my friends who have worked so hard in recovery to become better versions of themselves.To anyone who has done or is doing the work, I want to say thank you. Please know that the sharing of your stories over the years helps me to have compassion for this man who has wreaked havoc on my life, his own, and undoubtedly others.Maybe you have been the drunk driver, but most likely now you are the woman who came to my aid after I was hit, the neighbor who held onto his fellow man in the name of justice, the EMS who treated the offender, the nurse who later took my vitals, the friend who sent me flowers in the aftermath, the client who sent me groceries, the yoga teacher who offered healing words of support.Whether this will be this man’s rock bottom before getting help is not for me to say. I don’t believe in silver linings—you get what you get and deal with it. I am getting better every day. Yes, this incident sucks… and I am lucky to be alive and to know you. I wrote this thinking maybe someone reading it might recognize themselves and decide who they want to be in their own narrative.
After a man in my small Vermont town who had a heroin addiction committed suicide, I began asking questions about addiction. Numerous people shared their experiences with me — from medical workers to the local police to people in recovery. Shauna Shepard, who works as a receptionist in the local health clinic, visited with me on my back porch. She shared why she drifted into substance abuse, and how she struggled to get — and remain — sober.“Drugs,” Shauna finally said after a long silence, tapping her cigarette on the ashtray. “Drugs are really good. That’s the problem. When you’re using, it’s hard to imagine a life without them. For a long time, I didn’t know how to deal with my feelings any other way. It’s still hard for me to understand that getting high isn’t an option anymore.”I nodded; I knew all too well how using could be a carapace, a place to tuck in and hide, where you could pretend your life wasn’t unraveling.“You can go weeks, months, even years without using, and then you smell something or hear a certain song on the radio, or you see somebody, and — bam! — the cravings come right back. If you don’t keep your eye on that shit, it’ll get you.”“It? You mean cravings for drugs? Or your past?”“Both,” she said emphatically. “I mean, fuck. Emotions don’t go away. If you bury them, everything comes crashing out when someone asks you for a fucking pen, and they get the last six months of shit because they walked in at the wrong time.”I laughed. “So much shit can happen in six months.”She nodded, but she wasn’t smiling.I rubbed a fingertip around the edge of the saucer, staring at the ashes sprinkled over its center. “What’s it like for you to be sober?”“It’s harder. But it’s better. My job is good, and I want to keep it. I have money the day after I get paid. I’ve got my therapist and my doctor on speed dial. I have Vivitrol. But I still crave drugs. I don’t talk to anyone who uses. It’s easy for that shit to happen. You gotta be on your game.”“At least to me, you seem impressively aware of your game.”With one hand, she waved away my words. “I have terrible days, too. Just awful days. But if my mom can bury two kids and not have a drug issue, I should be able to do it. When my brother shot himself, his girlfriend was right there. She’s now married and has two kids. That’s just freaking amazing. If she can stay clean, then I should be able to stay sober, too.”“Can I reiterate my admiration again? So many people are just talk.”Shauna laughed. “Sometimes I downplay my trauma, but it made me who I am. I change my own oil, take out the garbage. I run the Weedwacker and stack firewood. I’ve repaired both mufflers on my car, just because I could.” Her jaw tightened. “But I don’t want to be taken advantage of.” She told me how one night, she left her house key in the outside lock. “When I woke up next morning and realized what I had done, I was so relieved to have survived. I told myself, See, you’re not going to fucking die.”“You’re afraid here? In small town Vermont?”“I always lock up at night. Always have, always will.” Cupping her hands around the lighter to shield the flame from the wind, she bent her head sideways and lit another cigarette.“I lock up, too. I have a restraining order against my ex.”She tapped her lighter on the table. “So you know.”“I do. I get it.”*As the dusk drifted in and the warm afternoon gave way to a crisp fall evening, our conversation wound down.Shauna continued, “I still feel like I have a long way to go. But I feel lucky. I mean, in my addiction I never had sex for money or drugs. I never had to pick out of the dumpster. My rock bottom wasn’t as low as others. I’m thankful for that.”I thought of my own gratitude for how well things had worked out for me, despite my drinking problem; I had my daughters and house, my work and my health.Our tabby cat Acer pushed his small pink nose against the window screen and meowed for his dinner. My daughter Gabriela usually fed him and his brother around this time.“It’s getting cold,” Shauna said, zipping up her jacket.“Just one more question. What advice would you give someone struggling with addiction?”Shauna stared up at the porch ceiling painted the pale blue of forget-me-not blossoms, a New England tradition. She paused for so long that I was about to thank her and cut off our talk when she looked back at me.“Recovery,” she offered, “is possible. That’s all.”“Oh . . .” I shivered. “It’s warm in the house. Come in, please. I’ll make tea.”She shook her head. “Thanks, but I should go. I’ve got to feed the dogs.” She glanced at Acer sitting on the windowsill. “Looks like your cat is hungry, too.”“Thank you again.”We walked to the edge of the driveway. Then, after an awkward pause, we stepped forward and embraced. She was so much taller than me that I barely reached her shoulders.When Shauna left, I gathered my two balls of yarn and my half-knit sweater and went inside the kitchen. I fed the cats who rubbed against my ankles, mewling with hunger. From the refrigerator, I pulled out the red enamel pan of leftover lentil and carrot soup I’d made earlier that week and set it on the stove to warm.Then I stepped out on the front steps to watch for my daughters to return home. Last summer, I had painted these steps dandelion yellow, a hardware store deal for a can of paint mistakenly mixed. Standing there, my bare feet pressed together, I wrapped my cardigan around my torso. Shauna and I had much more in common than locking doors at night. Why had I revealed nothing about my own struggle with addiction?*I wandered into the garden and snapped a few cucumbers from the prickly vines. Finally, I saw my daughters running on the other side of the cemetery, racing each other home, ponytails bobbing. As they rushed up the path, I unlatched the garden gate and held up the cucumbers.“Cukes. Yum. Did you put the soup on?” Molly asked, panting.“Ten minutes ago.” Together we walked up the steps. The girls untied their shoes on the back porch.“We saw the bald eagles by the reservoir again,” Gabriela said.“What luck. I wonder if they’re nesting there.”Molly opened the kitchen door, and the girls walked into our house. Before I headed in, too, I lined up my family’s shoes beneath the overhang. Through the glass door, I saw Molly cradling Acer against her chest, his hind paws in Gabriela’s hands as the two of them cooed over their beloved cat.Hidden in the thicket behind our house, the hermit thrush — a plain brown bird, small enough to fit in the palm of my hand — trilled its rippling melody, those unseen pearls of sound.In the center of the table where Shauna and I had sat that afternoon, the saucer was empty, save for crumbles of common garden dirt and a scattering of ashes. When I wasn’t looking, Shauna must have gathered her crushed cigarette butts. I grasped the saucer to dump the ashes and dirt over the railing then abruptly paused, wondering: If I had lived Shauna’s life, would I have had the strength to get sober? And if I had, would I have risked that sobriety for a stranger?In the kitchen, my daughters joked with each other, setting the table, the bowls and spoons clattering. The refrigerator opened and closed; the faucet ran. I stood in the dusk, my breath stirring that dusty ash.Excerpted from Unstitched: My Journey to Understand Opioid Addiction and How People and Communities Can Heal, available at Amazon and elsewhere.
Havana syndrome fits the pattern of psychosomatic illness – but that doesn’t mean the symptoms aren’t real
In early September 2021, a CIA agent was evacuated from Serbia in the latest case of what the world now knows as “Havana syndrome.”Like most people, I first heard about Havana syndrome in the summer of 2017. Cuba was allegedly attacking employees of the U.S. Embassy in Havana in their homes and hotel rooms using a mysterious weapon. The victims reported a variety of symptoms, including headaches, dizziness, hearing loss, fatigue, mental fog and difficulty concentrating after hearing an eerie sound.Over the next year and a half, many theories were put forward regarding the symptoms and how a weapon may have caused them. Despite the lack of hard evidence, many experts suggested that a weapon of some sort was causing the symptoms.I am an emeritus professor of neurology who studies the inner ear, and my clinical focus is on dizziness and hearing loss. When news of these events broke, I was baffled. But after reading descriptions of the patients’ symptoms and test results, I began to doubt that some mysterious weapon was the cause.I have seen patients with the same symptoms as the embassy employees on a regular basis in my Dizziness Clinic at the University of California, Los Angeles. Most have psychosomatic symptoms – meaning the symptoms are real but arise from stress or emotional causes, not external ones. With a little reassurance and some treatments to lessen their symptoms, they get better.The available data on Havana syndrome matches closely with mass psychogenic illness – more commonly known as mass hysteria. So what is really happening with so–called Havana syndrome?A mysterious illnessIn late December 2016, an otherwise healthy undercover agent in his 30s arrived at the clinic of the U.S. Embassy in Cuba complaining of headaches, difficulty hearing and acute pain in his ear. The symptoms themselves were not alarming, but the agent reported that they developed after he heard “a beam of sound” that “seemed to have been directed at his home”.As word of the presumed attack spread, other people in the embassy community reported similar experiences. A former CIA officer who was in Cuba at the time later noted that the first patient “was lobbying, if not coercing, people to report symptoms and to connect the dots.”Patients from the U.S. Embassy were first sent to ear, nose and throat doctors at the University of Miami and then to brain specialists in Philadelphia. Physicians examined the embassy patients using a range of tests to measure hearing, balance and cognition. They also took MRIs of the patients’ brains. In the 21 patients examined, 15 to 18 experienced sleep disturbances and headaches as well as cognitive, auditory, balance and visual dysfunction. Despite these symptoms, brain MRIs and hearing tests were normal.A flurry of articles appeared in the media, many accepting the notion of an attack.From Cuba, Havana syndrome began to spread around the globe to embassies in China, Russia, Germany and Austria, and even to the streets of Washington.The Associated Press released a recording of the sound in Cuba, and biologists identified it as the call of a species of Cuban cricket.A sonic or microwave weapon?Initially, many experts and some of the physicians suggested that some sort of sonic weapon was to blame. The Miami team’s study in 2018 reported that 19 patients had dizziness caused by damage to the inner ear from some type of sonic weapon.This hypothesis has for the most part been discredited due to flaws in the studies, the fact there is no evidence that any sonic weapon could selectively damage the brain and nothing else, and because biologists identified the sounds in recordings of the supposed weapon to be a Cuban species of cricket.Some people have also proposed an alternative idea: a microwave radiation weapon.This hypothesis gained credibility when in December 2020, the National Academy of Science released a report concluding that “pulsed radiofrequency energy” was a likely cause for symptoms in at least some of the patients.If someone is exposed to high energy microwaves, they may sometimes briefly hear sounds. There is no actual sound, but in what is called the Frey effect, neurons in a person’s ear or brain are directly stimulated by microwaves and the person may “hear” a noise. These effects, though, are nothing like the sounds the victims described, and the simple fact that the sounds were recorded by several victims eliminates microwaves as the source. While directed energy weapons do exist, none that I know of could explain the symptoms or sounds reported by the embassy patients.Despite all these stories and theories, there is a problem: No physician has found a medical cause for the symptoms. And after five years of extensive searching, no evidence of a weapon has been found.Mass psychogenic illness – more commonly known as mass hysteria – is a well-documented phenomenon throughout history, as seen in this painting of an outbreak of dancing mania in the Middle Ages. Pieter Brueghel the Younger/WikimediaCommonsMass psychogenic illnessMass psychogenic illness is a condition whereby people in a group feel sick because they think they have been exposed to something dangerous – even though there has been no actual exposure. For example, as telephones became widely available at the turn of the 20th century, numerous telephone operators became sick with concussion-like symptoms attributed to “acoustic shock.” But despite decades of reports, no research has ever confirmed the existence of acoustic shock.I believe it is much more likely that mass psychogenic illness – not an energy weapon – is behind Havana syndrome.Mass psychogenic illness typically begins in a stressful environment. Sometimes it starts when an individual with an unrelated illness believes something mysterious caused their symptoms. This person then spreads the idea to the people around them and even to other groups, and it is often amplified by overzealous health workers and the mass media. Well-documented cases of mass psychogenic illness – like the dancing plagues of the Middle Ages – have occurred for centuries and continue to occur on a regular basis around the world. The symptoms are real, the result of changes in brain connections and chemistry. They can also last for years.The story of Havana syndrome looks to me like a textbook case of mass psychogenic illness. It started from a single undercover agent in Cuba – a person in what I imagine is a very stressful situation. This person had real symptoms, but blamed them on something mysterious – the strange sound he heard. He then told his colleagues at the embassy, and the idea spread. With the help of the media and medical community, the idea solidified and spread around the world. It checks all the boxes.Interestingly, the December 2020 National Academy of Science report concluded that mass psychogenic illness was a reasonable explanation for the patients’ symptoms, particularly the chronic symptoms, but that it lacked “patient-level data” to make such a diagnosis.The Cuban government itself has been investigating the supposed attacks over the years as well. The most detailed report, released on Sept. 13, 2021, concludes that there is no evidence of directed energy weapons and says that psychological causes are the only ones that cannot be dismissed.While not as sensational as the idea of a new secret weapon, mass psychogenic illness has historical precedents and can explain the wide variety of symptoms, lack of brain or ear damage and the subsequent spread around the world.[Understand new developments in science, health and technology, each week.Subscribe to The Conversation’s science newsletter.]Robert Baloh, Professor of Neurology, University of California, Los AngelesThis article is republished from The Conversation under a Creative Commons license. Read the original article.
The officer standing in the doorway raised his arm when I stepped forward, blocking my entrance to my son’s apartment. I tried to peer over his blue-uniformed shoulder to gaze around the corner to where the body of my son sat on the couch. My precious William—I saw him take his first breaths at birth, and I’d cried as I looked down at him and pledged to keep him safe forever. Now, within a day of his final breath, I wanted to see him again.“Please,” I said to the officer.“Listen,” he said, and I dragged my eyes from straining to see William to the officer’s face. His brown eyes were stern but not unkind. “You don’t want to see this.”“I do,” I said. “It’s my son.”He glanced over his shoulder, then back at me. “Death isn’t pretty,” he said. “He’s bloated. His bowels turned loose. That’s what happens when people die and are left alone for a day or more.”I didn’t say anything. I couldn’t.“And there’s something else,” he said.“What?”“He’s still got a $20 bill rolled up in his hand used for whatever he was snorting.”I felt the pavement beneath my feet seem to tilt. I reached to steady myself on the splintered doorjamb one of the officers had forced open with a crowbar just minutes before.At his hip, the officer’s radio squawked. I knew the ambulance would be here soon. “Your son—we found him with his iPad in his lap. It looks like he was checking his email to see what time he was due at work in the morning.”Yes, William was proud of holding down that job at the Apple Store. He was trying to turn things around.“It’s typical, really,” the officer continued. “That’s how addicts are. Snorting a fix while hoping to do right and get to work the next day. It’s always about the moment.”This past year, William had been the chief trainer at the Apple Store, and he’d been talking again about heading to law school, the old dream seeming possible once more now that he was sober. He seemed to have put the troubles of the previous year, with his fits and starts in treatment, behind him. They’d kicked William out of one center in Colorado because he drank a bottle of cough syrup. Another center tossed him out because he and a fellow rehabber successfully schemed over two weeks to purchase one fentanyl pill each from someone in the community with a dental appointment. They swallowed their pills in secret, but glassy eyes ratted them out to other patients, who alerted counselors. When asked, William confessed, hoping the admission might move the counselors to give him a second chance. But they sent him packing back to Nashville, where his rehab treatment had begun. One counselor advised us to let William go homeless. “We’ll drop him off at the Salvation Army with his clothing and $10,” he said. “Often, that’s what it takes.”We knew that kind of tough-love, hit-rock-bottom stance might be right, but our parental training couldn’t stomach abandoning our son to sleep at the Salvation Army. Instead, my wife and I drove five hours from our home in Mississippi to Nashville to pick him up. He was fidgety but he hugged us firmly, looking into our eyes. We took him to dinner at Ruth’s Chris Steak House, and, Lord, it felt good to see his broad smile, our twenty-two-year-old son adoring us with warm, brown eyes. We told stories and laughed and smiled and swore the bites of rib eye drenched in hot butter were the best we’d ever had.The next morning, after deep sleep at a Hampton Inn under a thick white comforter with the air conditioner turned down so low William chuckled that he could see his breath, we found a substance treatment program willing to give him another chance.“This dance from one treatment center to another isn’t unusual,” a counselor explained at intake. “Parents drop their child off for a thirty-day treatment and assume it’s going to be thirty days. But that’s just the tip of the iceberg.” My wife and I exchanged a look; that’s exactly what we’d thought the first time we got William treatment. Thirty days and we’d have our boy home, safe and healthy.The counselor continued, “If opiates and benzos are involved, it often takes eight or nine thirty-day stays before they find the rhythm of sobriety and self-assuredness. The hard part for them is staying alive that long.”When we left William in Nashville for that first thirty-day treatment, weeks before Thanksgiving, we imagined we’d have him home for Christmas. In early December, we bought presents that we expected to share, sitting around the tree with our family of five blissfully together. But William needed more treatment. Thanksgiving turned into Christmas, and Christmas turned into the new year, and the new year turned into spring. We missed William so much, but finally, the treatment was beginning to stick. We saw progress in William’s eyes during rare visits, the hollowness carved by substances slowly refilling with remnants of his soul.Now, when parents ask me how they can tell if their kid is on drugs, I say, “Look into their eyes.” Eyes reveal the truth, and eyes cannot hide lies and pain. In William’s eyes, we saw hopeful glimmers that matched improved posture and demeanor. Progress, however, can become the addict’s worst enemy since renewed strength signals opportunity. Addicts go to rehab because substances knocked them down, yet once they are out of treatment and are feeling more confident, they forget just how quickly they can be knocked down again.Yet we, too, were feeling confident about William’s prospects. He’d always been scrappy, a hard worker. In college, he ran the four-hundred-meter hurdles in the Southeastern Conference Outdoor Track and Field Championships, despite the fact that he had short legs for a college hurdler. He overcame that by being determined, confident, and quick. And all the time he was competing at the Division 1 level, he was an A student in the Honors College. He’d set his mind on law school and people had told us that with his resumé he could get into most any law school in America.During that year after his graduation, in 2012, when William was in and out of treatment, I decided to quit my job as a newspaper editor to spend more time with him. I wanted to keep an eye on his progress and be there if he started to slide, so I visited him in Nashville every other week. He worried I was throwing my career away, but I would throw away anything to help him. Also, I had a plan. Instead of the daily grind of editing a newspaper, I thought quitting might provide the opportunity to return to a book project I’d abandoned. The Greatest Fight Ever was my take on the John L. Sullivan versus Jake Kilrain bare-knuckle boxing match of the late 1800s. The Sullivan-Kilrain fight was an epic heavyweight championship held in South Mississippi, lasting seventy-five rounds in sultry July heat, part showmanship theater and part brute brawl. I had researched the story for years and was once excited about explaining its role in the playing—and hyping—of sports today. I enjoyed sharing anecdotes over the years, like how the mayor of New Orleans served as a referee. Or that the notorious Midwestern gunslinger Bat Masterson took bets ringside on the fight, which set the standard for sports’ bigger-than-life culture that continues today.I had written other books by then, including some that found commercial success, but looking back at them from a distance, I judged none to be as excellent and useful as they could have been. I wanted the Sullivan-Kilrain fight story to change that. But William noticed as we visited that my enthusiasm for the story had evaporated. I wasn’t spending time crafting the manuscript.“You need to finish your book,” William said that April when I visited him in Nashville. We were eating breakfast at a café known for pancakes, but I was devouring bacon and eggs as William wrestled with a waffle doused with jelly.“I’m trying,” I said between sips of coffee. “It’s easy to tell a story, but it’s more difficult to tell a good story. That’s what I’m working at.”“You are a good writer. You can do it if you get focused.”“It’s hard to immerse yourself in a championship boxing match from the 1800s when you and your family are in the fight of a lifetime,” I said.William looked at me over his jelly-slathered waffle. He knew I wasn’t just referring to his struggles. I was referring to my own as well. Two years earlier, I’d almost destroyed our family completely through a string of spectacularly bad decisions, and we, individually and collectively, were fragile.“William,” I said. “I’m worried about you. I’m worried about me. I’m worried about all of us.”We hadn’t talked so much about my own self-immolation. But now William turned to me. “I’m sorry if the mistakes I’ve made were what made it worse for you. I mean—” he looked off and took a breath. “For so long, I thought drugs were for fun, and I didn’t realize how deep I was in. And then it was too late. I needed them. I’m sorry for making it harder on you and Mom.”“No, William, don’t put that on yourself. I caused my own problems. And I want to apologize to you too. I’m sorry for when you struggled in college and I was so caught up in my own life or career that I wasn’t there when you needed me. I failed you.”We went on that way for a while, saying the things that had burdened us, the things we’d needed to say for a long time. That weekend was our best, most direct connection in years. I was glad to sit beside my son over coffee and a breakfast we could live without for conversation we’d been dying for, glad I’d quit a decent editing job, glad even to stop pretending I was writing a book that no longer held my interest.“Maybe there’s another book you should be writing, Dad,” he said.“About sports?”“About us.”I looked at his plate, the waffle barely eaten. I looked at his eyes, shining with encouragement.“Do you ever think maybe other people could learn something from hearing about our story? I mean, when we were growing up, no one would have looked at our family, this all-American family that pretty much lacked for nothing, and predict how bad we’d crash. But maybe hearing what happened to us could help people. Maybe that’s the story you should tell.”“Maybe we should tell it together,” I said after a bite.“I’m not ready yet,” he said. “But one day, we’ll do it.”“Yes,” I said, clutching his hand in mine. “One day, we’ll do it.”We said goodbye then and told each other we loved each other, and I walked to my car.“Dad,” William called out.“Yeah?” I turned over my shoulder.“Make sure you finish that book,” he said.I stopped. “What book? The Greatest Fight Ever?”He smiled and waved goodbye.I wiped tears away, then drove home.That was the last time I ever saw my firstborn child.Five sleeps later, William died. He didn’t plan on dying. But the early days of sobriety can be the loneliest days. And it’s never hard for an addict to find an excuse. Excerpted from Dear William: A Father's Memoir of Addiction, Recovery, Love, and Loss by David Magee, available November 2, 2021 at Amazon and elsewhere.
Vegetarian and vegan options have become standard fare in the American diet, from upscale restaurants to fast-food chains. And many people know that the food choices they make affect their own health as well as that of the planet.But on a daily basis, it’s hard to know how much individual choices, such as buying mixed greens at the grocery store or ordering chicken wings at a sports bar, might translate to overall personal and environmental health. That’s the gap we hope to fill with our research.We are part of a team of researchers with expertise in food sustainability and environmental life cycle assessment, epidemiology and environmental health and nutrition. We are working to gain a deeper understanding beyond the often overly simplistic animal-versus-plant diet debate and to identify environmentally sustainable foods that also promote human health.Building on this multi-disciplinary expertise, we combined 15 nutritional health-based dietary risk factors with 18 environmental indicators to evaluate, classify and prioritize more than 5,800 individual foods.Ultimately, we wanted to know: Are drastic dietary changes required to improve our individual health and reduce environmental impacts? And does the entire population need to become vegan to make a meaningful difference for human health and that of the planet?Putting hard numbers on food choicesIn our new study in the research journal Nature Food, we provide some of the first concrete numbers for the health burden of various food choices. We analyzed the individual foods based on their composition to calculate each food item’s net benefits or impacts.The Health Nutritional Index that we developed turns this information into minutes of life lost or gained per serving size of each food item consumed. For instance, we found that eating one hot dog costs a person 36 minutes of “healthy” life. In comparison, we found that eating a serving size of 30 grams of nuts and seeds provides a gain of 25 minutes of healthy life – that is, an increase in good-quality and disease-free life expectancy.Our study also showed that substituting only 10% of daily caloric intake of beef and processed meats for a diverse mix of whole grains, fruits, vegetables, nuts, legumes and select seafood could reduce, on average, the dietary carbon footprint of a U.S. consumer by one-third and add 48 healthy minutes of life per day. This is a substantial improvement for such a limited dietary change.Relative positions of select foods, from apples to hot dogs, are shown on a carbon footprint versus nutritional health map. Foods scoring well, shown in green, have beneficial effects on human health and a low environmental footprint. (Austin Thomason/Michigan Photography and University of Michigan, CC BY-ND)How did we crunch the numbers?We based our Health Nutritional Index on a large epidemiological study called the Global Burden of Disease, a comprehensive global study and database that was developed with the help of more than 7,000 researchers around the world. The Global Burden of Disease determines the risks and benefits associated with multiple environmental, metabolic and behavioral factors – including 15 dietary risk factors.Our team took that population-level epidemiological data and adapted it down to the level of individual foods. Taking into account more than 6,000 risk estimates specific to each age, gender, disease and risk, and the fact that there are about a half-million minutes in a year, we calculated the health burden that comes with consuming one gram’s worth of food for each of the dietary risk factors.For example, we found that, on average, 0.45 minutes are lost per gram of any processed meat that a person eats in the U.S. We then multiplied this number by the corresponding food profiles that we previously developed. Going back to the example of a hot dog, the 61 grams of processed meat in a hot dog sandwich results in 27 minutes of healthy life lost due to this amount of processed meat alone. Then, when considering the other risk factors, like the sodium and trans fatty acids inside the hot dog – counterbalanced by the benefit of its polyunsaturated fat and fibers – we arrived at the final value of 36 minutes of healthy life lost per hot dog.We repeated this calculation for more than 5,800 foods and mixed dishes. We then compared scores from the health indices with 18 different environmental metrics, including carbon footprint, water use and air pollution-induced human health impacts. Finally, using this health and environmental nexus, we color-coded each food item as green, yellow or red. Like a traffic light, green foods have beneficial effects on health and a low environmental impact and should be increased in the diet, while red foods should be reduced.Where do we go from here?Our study allowed us to identify certain priority actions that people can take to both improve their health and reduce their environmental footprint.When it comes to environmental sustainability, we found striking variations both within and between animal-based and plant-based foods. For the “red” foods, beef has the largest carbon footprint across its entire life cycle – twice as high as pork or lamb and four times that of poultry and dairy. From a health standpoint, eliminating processed meat and reducing overall sodium consumption provides the largest gain in healthy life compared with all other food types.Beef consumption had the highest negative environmental impacts, and processed meat had the most important overall adverse health effects. (ID 35528731 © Ikonoklastfotografie | Dreamstime.com)Therefore, people might consider eating less of foods that are high in processed meat and beef, followed by pork and lamb. And notably, among plant-based foods, greenhouse-grown vegetables scored poorly on environmental impacts due to the combustion emissions from heating.Foods that people might consider increasing are those that have high beneficial effects on health and low environmental impacts. We observed a lot of flexibility among these “green” choices, including whole grains, fruits, vegetables, nuts, legumes and low-environmental impact fish and seafood. These items also offer options for all income levels, tastes and cultures.Our study also shows that when it comes to food sustainability, it is not sufficient to only consider the amount of greenhouse gases emitted – the so-called carbon footprint. Water-saving techniques, such as drip irrigation and the reuse of gray water – or domestic wastewater such as that from sinks and showers – can also make important steps toward lowering the water footprint of food production.A limitation of our study is that the epidemiological data does not enable us to differentiate within the same food group, such as the health benefits of a watermelon versus an apple. In addition, individual foods always need to be considered within the context of one’s individual diet, considering the maximum level above which foods are not any more beneficial – one cannot live forever by just increasing fruit consumption.At the same time, our Health Nutrient Index has the potential to be regularly adapted, incorporating new knowledge and data as they become available. And it can be customized worldwide, as has already been done in Switzerland.It was encouraging to see how small, targeted changes could make such a meaningful difference for both health and environmental sustainability – one meal at a time.[You’re smart and curious about the world. So are The Conversation’s authors and editors. You can get our highlights each weekend.]Olivier Jolliet, Professor of Environmental Health Sciences, University of Michigan and Katerina S. Stylianou, Research Associate in Environmental Health Sciences, University of MichiganThis article is republished from The Conversation under a Creative Commons license. Read the original article.
Tarzana Recovery Center (TRC) is a residential treatment center based in the San Fernando Valley neighborhood of Tarzana that provides treatment for substance use disorder, alcohol use disorder, dual diagnosis, and more. The facility offers an accredited sub-acute detox program certified by Integrated Management Systems. Treatment at Tarzana Recovery Center also features an array of in-residence plans and case management, as well as a partial hospitalization program (PHP) as part of their program aftercare. As their website notes, their inpatient treatment seeks to assist clients in achieving and sustaining long-term sobriety, and to guide clients on "a path of physical, mental, and spiritual health."Surveyed alumni gave a number of reasons for choosing TRC for treatment. The most frequently cited factors were the quality of treatment and accommodations, privacy, price, and location, with quality of treatment ranking highest among respondents. One alum noted that the staff and fellow clients "felt like family, [and] I will remain in touch and some will remain lifelong friends, I hope." Accommodations, which were the second most frequently cited reason, range from shared rooms with roommates to single room options; roommates were "very respectful" and even "awesome." Clients are expected to keep their rooms clean but are not assigned chores. Alumni described their fellow residents as a "refreshingly wide range of people." Clients were a mix of men and women of all ages and ethnicities, and many were described as professional, but there were "college student age people" as well. Alumni considered their fellow clients "regular people looking to address what was holding them back in life." The average length of stay was 30 days, and the most common issue driving respondents to seek treatment at TRC was substance use disorder. Others sought help for alcoholism or "dual addiction(s)," "gender-identity issues," "relationship issues," and "compulsive behaviors."The food served at TRC was described as "very gourmet" but also with a "home meal feeling." Meals were frequently described as "healthy" and clients were allowed to "have choices and input" on the menu selections. Clients with vegan diets were pleased with the range of options available to them, while fresh fish and seafood and Italian food were cited as favorite meals, as was the cookout that is offered as part of TRC's many activities. Coffee was made several times a day, and snacks were both plentiful and healthy. One alum felt the food was "too healthy," while another was "grateful to have a meal."Alumni described their days at TRC as "busy," with frequent involvement in a number of different activities. A couple former residents noted that staying busy is "part of the deal at Tarzana," with an emphasis on "getting and staying involved in your life." The program was "well-structured" and "with an emphasis on recovery through recreation and learning to have fun sober." TRC's treatment includes a "custom treatment plan" developed with the client, as well as one-on-one meetings with a residential treatment case manager – typically, a certified alcohol and drug counselor and a personal therapist. Evidence-based therapies such as cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and eye movement desensitization and reprocessing (EMDR) are also offered, as is meditation, equine therapy, pet therapy, music therapy, yoga, and professional massage therapy.While TRC's program does include a 12-step element, alumni viewed it as just one part of their treatment plan. "I think the foundation is somewhat 12-step, but they were really trying to provide me with something I wouldn't find in meetings alone," wrote one alum. Others appreciated the fact that the emphasis seemed to be more on "learning to actually live one's life sober and have fun." Most cited the groups and interaction with the staff as the most memorable element of their stay at TRC. Staff was regarded as "very caring and engaged" and "very understanding," but also with an element of tough love, which many considered "out of love and care."During non-treatment hours, clients had a number of activities and amenities available to them. The latter includes a pool, gym facilities, and fitness classes, while volleyball, cooking classes, bike riding were among the many activities. Clients could also take advantage of numerous off-site activities, including trips to the beach, surfing, bowling, virtual reality gaming, go-kart racing, and other weekend options, which were "super enjoyable."Access to a phone was described by alumni as "liberal" but also restricted while in detox, during group sessions, as well as after 10 p.m. (phones were returned at 10 a.m.). Access to television, Internet, media, and work obligations were "frequent" and the staff was "accommodating" in that regard.TRC's treatment includes 24/7 care from a diverse array of medical professionals, from doctors and nurse practitioners to therapists, mental health counselors, and alcohol and drug rehab technicians. The staff was described as "very helpful" and "always on call." Doctors were even available upon request via Facetime and Zoom, which was "helpful," while counselors at TRC were described as "exceptional."When asked about how they've fared since treatment at TRC, all respondents answered that they had been successful in maintaining sobriety for months, with some approaching their first year without substances. Some found it more challenging that others; as one alumni noted, "It is a daily reprieve. However, the tools they provided me have helped me stay clean for nine months now." Another reported feeling "far better equipped to handle things in my life" and one summed up: "I have never been this proud of myself."When asked to summarize their time in treatment at TRC, many alumni expressed gratitude for the center's staff. "I feel VERY fortunate to have found this treatment center," wrote one alum. Another noted that the staff made them feel "at home," and praised the staff for being "here to help me with whatever I needed." One cited an example of the staff's willingness to help by noting that transportation was arranged for a homeless client to come to Tarzana and stay for free, adding that the client "turned his life around."Another seemed to encompass their fellow alum's feelings by "highly recommend[ing] it to the next addict." They added that "the program helped me become the person I am right now, and I can't thank them enough."
January may be the time for New Year’s resolutions, but for many people September presents another opportunity for a fresh start. Kids return to school, the chaotic summer schedules quiet down, and many people transition into their fall and winter routines. That makes September a perfect time to check in on your routines, evaluate what’s working and what’s not, and make the changes you need to live your healthiest life.Here’s how to get started.Check in with yourselfBefore you make any big changes, take some time to check in with yourself. Journaling can be helpful, but you can also just take yourself on a walk or find another way to have an internal conversation, uninterrupted. Ask yourself what feels good in your life right now? What changes are just screaming to be made? Use these as directions to evaluate what you should do next.Make a listAfter you’ve taken some time to think about what you’d like to keep and change in your life, get out your pen and paper and make a list. The staff at Sunshine Coast Health Centre, a non 12-step drug and alcohol rehabilitation center in British Columbia, recommend making three lists to evaluate different areas of your life. First, start with a list of things you’re grateful for. Next, list your preferred activities, or the ways that you enjoy spending time. This can guide you in deciding how to prioritize and schedule your time. Finally, list the resources that are available to you if needed.Update your routineSummer can be a tough time to keep on schedule. The free and easy living is nice, but can become overwhelming after a while. Think about what you let slip from your routine, and what you would like to reincorporate. This is especially important as society begins opening up again. You might have the opportunity to volunteer, participate in alumni programs or take in-person classes for the first time in more than a year. Look back on your list of preferred activities and determine how you can incorporate more of those into your days.Get organized. Cooler weather means that most people will be spending more time inside during the coming months. To keep yourself happy and healthy, you should start with a clean slate in the house. Removing unnecessary clutter can help you keep a clear head, and knowing that all of your belongings have a physical space where they belong can help you stay organized. If you feel overwhelmed, start with one room at a time, donating things you no longer use and finding systems that work for the things you have left.Reach out for help.Think back to that last list you made: the resources that are available to you. These might be community programs, alumni supports or people you have close relationships with. Now, think about the areas in your life where you could use a bit of extra support. How can you use your resources to build your strengths in those areas? Maybe you’re looking to get more physical activity, and could recruit a friend to be your gym or walking buddy. Perhaps you can utilize a free community credit resources to help get your finances back in order. Remember: we all need support sometimes, and reaching out for help is a strength, not a weakness.Set a sleep routine. What’s the key to good mental, physical and emotional health? For many people, it’s getting a solid night’s sleep. Tweek your routine so that you get the recommended 8 hours of shut-eye. If you are a parent, try to get the kids in bed earlier so that you can have some time to yourself, but still get to bed at a recent hour. If you have trouble sleeping, remember to shut down the screens and turn to an old-fashioned book or bath in the hour before bed.Decide to say no.Sometimes, what you say no to is just as important as the things you decide to do. Especially after a year at home, there’s a temptation to take every opportunity, but that can leave you overstimulated and overtired. Instead of diving back into everything all at once, choose a few meaningful (or preferred) activities to focus on. Set boundaries on things that stress you out, whether it’s joining the PTA or helping with carpooling. Remember, your time is one of your most valuable resources, and you get to decide how to spend it.It’s not a new year, but it is a new start in many areas of North America. At this junction you can decide what you want your fall and winter to be like, and what you would like to leave behind.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.