Substance Abuse:  The Poorest of Poor Lifestyle Choices!

Substance abuse covers a wide spectrum.  It generally means using a substance to the extent that it causes harm; health degradation, family strife, financial problems, or poor job performance and/or attendance.

Usually "substance" applies to alcohol but also includes prescription drugs, illegal drugs, tobacco use and use of chemicals, solvents and the like that produce an intoxicating "high".

It's not like anyone intentionally decides to become a substance abuser.  Do you know of anyone who woke up one day and just decided to become an alcoholic, or a drug addict, or made a conscious decision to puff themselves into lung cancer?

Substance abuse is a baited trap, just waiting to be sprung.  The bait is the desire to fit in with the crowd, be cool, feel good, ease stress, forget about problems for awhile, be in control, sharpen the mind, improve athletic performance, and any number of rationales the mind can invent.

The temptations are very seductive as well and they sneak up on us.  In only takes about 10 days for an activity to become a habit and not much longer after that to become an addiction.

There is a famous quote by an unknown author that goes something like...

Watch your thoughts, for they become words.
Watch your words, for they become actions.
Watch your actions, for they become habits.
Watch your habits, for they become character.
Watch your character, for it becomes your destiny.

In "Silence of the Lambs", Hannibal Lechter explained to Clarice that the eyes are the doorway to temptation.  What we see, all too often, leads to those alluring thoughts.  

If you're a kid in school and you see the in-crowd smoking and drinking, maybe you get the thought that, "hey, if I do that, I'll be somebody too".  Then the thought leads to the words, "Can I bum a smoke", or "What does that taste like, can I try it?"  

Stereotype of the Town Drunk, Gustav Imlauer, 1883

The next step is the action, and a series of repeat actions and after enough indulgence, the habit is established. 

After awhile, the habit defines character and how we are viewed; a smoker, a drunk, a user, a loser, a whatever.  Destiny is measured in years. 

Photo:  Old Stereotype of the Town Drunk

For some it's the drunk tank, for some it's a series of rehab facilities, for some it's cancer treatments or kidney dialysis, for some it's divorce court, the unemployment line, food stamp line; and for some it's a jail cell, the morgue and potter's field.

OK, that's a pretty bleak picture.  After all, not everyone that smokes or drinks ends up in the gutter or with ruined health...but too many do and that's the focus of this page.

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The Menu of Substance Abuse

There is no shortage of "substances" that people can choose to abuse.  Normally the phrase "substance abuse" brings alcohol to mind and maybe tobacco, marijuana and sometimes cocaine or meth.  The list is a lot longer than that, in fact, it's a very broad menu.

If anyone is looking for some additional source material, WebMD has a very good overview of substance abuse including signs and symptoms, addiction, treatment and much more.

Just click on the link to go there.

Continuing on, we can roughly divide them into five categories; depressants, stimulants, hallucinogens, psychotherapeutic drugs and steroids.

But before going on, here's an introduction to a professional level book, "Drugs and Society" for anyone wanting a university level text on the subject.

The Twelfth Edition of Drugs and Society clearly illustrates the impact of drug use and abuse on the lives of ordinary people and provides students with a realistic perspective of drug-related problems in our society.

Drugs And Society (Hanson, Drugs and Society)

Written in an objective and user-friendly manner, this best-selling text continues to captivate students by incorporating personal drug use and abuse experiences and perspectives throughout. Statistics and chapter content have been revised to include the latest information on current topics.

Click on the "Drugs and Society" link or the book cover above for more information or to order.  Now, moving on....

Depressants

Depressants are aptly named since that is exactly what they do.  They depress a person's level of alertness and the overall activity of the brain.

In low doses, depressants cause a sensation of calm, sleepiness, and well-being. People on depressants are less aware of their environment.

In higher doses, some depressants can cause serious intoxication that leads to loss of consciousness, coma, or even death. The regular use of depressants is highly likely to result in physical and psychological dependency.

The depressants generally involved in substance abuse are:

  • Alcohol; which includes beer, wine, and hard liquor
  • Opiates are derivatives of constituents found in opium, harvested from the sap of the opium poppy. The major biologically active opiates found in opium are morphine, codeine, thebaine and papaverine. Synthetic opioids such as heroin and hydrocodone are derived from these substances, especially morphine and codeine.
  • Anxiolytics is a name given to the broad spectrum of drugs given to control the symptoms of anxiety. They include sedatives and hypnotics (also known as minor tranquilizers). The sedatives are classed as Benzodiazepines and include Valium, Ativan, Serax, Xanax, Restoril, Dalmane, Halcion, and Rohypnol. The Barbiturates include Seconal, Nembutal, Amytal and Tuinal. Barbiturates carry a high risk of abuse and addiction is high and they are rarely prescribed today.
  • Stimulants

    Stimulants, like depressants are also aptly named.  They produce a rapid, temporary burst of energy and increase alertness, endurance, and mental acuity.

    Minor stimulants are not usually viewed as candidates for substance abuse.  Coffee, tea, cocoa, chocolate and even some cola drinks are minor stimulants, as is nicotine.  They can help people to stay awake, suppress appetite and provide a feeling of euphoria and well-being.

    The major stimulants are another story.  Some stimulants, such as cocaine, can create a serious psychological and physical dependency.  Besides cocaine, they include various amphetamines like Adderall, Vyvane and Dexedrine; all of which act by increasing levels of norepinephrine, serotonin, and dopamine in the brain...more on that later.

    Hallucinogens

    Hallucinogens dredge up memories of Haight Ashbury, the 60's and hippies; these are the “psychedelic drugs”.  They cause varying degrees of changes in mood and cognitive processes often distorting a person's sense of reality and, with excessive use, producing hallucinations.

    Some, such as cannabis, produce a depressive effect while increasing the heart rate.  Marijuana and hashish are the two cannabis drugs of choice for most users of hallucinogens.  The chemical hallucinogens are LSD, Ecstasy, Mescaline, Ketamin and PCP.

    Psilocybin from mushrooms is another hallucinogenic although we don't hear much about mushroom substance abuse.

    Psychotherapeutic Medications

    Antidepressants are medications used to treat depression and other mental problems such as obsessive compulsive disorder, bulimia, and panic attacks.

    Antidepressants include tricyclics such as Elavil and Anafranil; the monoamine oxidase inhibitors (MAOI) Parnate, Nardil and others; and the serotonin reuptake inhibitors Prozac, Zoloft and similar drugs.

    Antipsychotics or neuroleptics (also known as “major tranquilizers”) are psychiatric medications primarily used to manage psychosis such as delusions, hallucinations, or disordered thought.  Schizophrenia and bipolar disorder are favored targets of these types of drugs.

    Overactive kids or kids that seem to have trouble focusing or paying attention in class are usually diagnosed as having Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). 

    What is often normal behavior for a bored student is all of sudden classified as ADD or ADHD and the child kept on a series of drugs such as Ritalin, Dexedrine, Concerta, Metadate, Focalin, and Adderall.  A lot of psychiatrists are getting very rich by keeping our young people drugged up.

    Anabolic Steroids

    Anabolic steroids are substances used to enhance the body’s performance by promoting the development of muscle mass and endurance. Though steroids are banned in major sporting competitions and can cause considerable health damage, many athletes continue to use them.

    Our Brain; The Greatest Enabler
    Of Substance Abuse

    When it comes to substance abuse, our brain chemistry is the biggest enabler.  We have a built in reward system in our brains that works to reinforce destructive behavior.  In fact it's called the Endogenous Reward system.

    Words just aren't adequate to describe the complexity of our brain and the scope of what it can do.  For example, it has the ability to distinguish about 6 million hues of color.  If it can do that with color, just think of the range of emotion that it enables us (or causes us) to experience.

    There is a huge network of interconnecting nuclei and structures in the brain, called the limbic system, which makes all that happen.  It is a subsystem of the limbic system that causes pleasurable activity to give us the euphoric response.

    As with all brain activity, neurotransmitters are involved which, in the case of pleasure, are the monoamines.  Basically, they increase the feeling of pleasure, so it follows that drugs that are designed to treat depression, increase the level of monoamines, mostly serotonin and epinephrine.

    In plain language, we seek out pleasure or reward activities because the brain chemicals they release make us feel good.  If something gives you pleasure or joy of life, thank your cortex.

    Let's dissect our brain's endogenous reward system and see what makes it tick.  Remember we said it is part of limbic system and responsible for the very subjective experience of pleasure.

    This very complex system is both neuro-anatomical and biochemical in nature.

    Anatomy of Substance Abuse

    Anatomically, it consists of the nuclei and pathways in the limbic system.  By the way, a brain nucleus is nothing like the nucleus of an atom or a cell.  It is a bundle of nerve cell bodies that form a structure with a unique architecture, connections and function.


    Structural pathway of Substance Abuse


    The first brain nuclei involved in the addiction process is the ventral tegmental area (VTA), a very small area in the midbrain just below and forward of hippocampus and behind the amygdala. 

    It connects to the other nuclei of the endogenous reward system; the nucleus accumbens septi (NAS), the orbitofrontal cortex (OFC) and the  prefrontal cortex (PFC).

    Dopamine is the neurotransmitter used by the ventral tegmental area and in every case of addiction, the nucleus accumbens septi are involved.  All of this projects to the brain's left hemisphere where it stimulates the left prefrontal area of the pleasure system.

    Since we are focusing on the brain and addiction, this is a good place to mention a DVD or downloaded course from The Great Courses titled Understanding the Brain.

    It is a 36-lecture course taught by Dr. Jeanette Norden of the Vanderbilt University School of Medicine and is an incredible learning experience and will increase your understanding of how this organ inside our skull works.  Click the Great Courses button below to look it over.


    Biochemical Mechanism of
    Substance Abuse

    Dopamine provides feelings of enjoyment and through the reinforcement mechanism, motivates a person to seek out opportunities to engage in pleasurable activities. 

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    It is released in the nucleus accumbens septi and prefrontal cortex by naturally rewarding experiences such as food, sex, drugs, and neutral stimuli that become associated with them.

    This theory is widely discussed in terms of substance abuse of cocaine, nicotine, and amphetamines.  These substances seem to lead to an increase of dopamine in these areas and it is believed that these dopamine pathways are pathologically altered in addicted persons. 

    In addition to pleasurable activities, recent studies indicate that aggression may also stimulate the release of dopamine thus leading to an increase in aggressive behavior.

    There is an ample amount of clinical evidence based on animal research that supports the addictive side of dopamine. 

    Researchers put electrodes in the pleasure centers of the animal's brain and train them to press a bar to get an electrical stimulation. Observations were that they will keep pressing the bar to receive the pleasurable stimulus to the point of exhaustion and even starving to death for the pleasure response.  Who would imagine that death by substance abuse would feel so good?

    These are the same areas that are stimulated under natural or normal conditions by eating, drinking or sex. 

    But as shown in the clinical research, drugs such as cocaine can stimulate these pathways and the test animal will hit the bar for a bit of cocaine and refuse sex, food and anything else to get that hit of coke.  It was not unusual for the addiction to manifest from very first hit.

    Individuals who are cocaine addicts talk about whole body euphoria and elation that a non-user can't imagine. On MRI, pleasure areas of brains light up, and in imaging studies of human brains, even the anticipation of pleasure stimulates these areas.

    In humans, the greatest activation of brain response occurs when anticipation is paired with some degree of uncertainty.  This may explain why gambling as an addiction may be as hard to overcome as substance abuse.

    Substance abuse can damage the endogenous reward system or alter it to the extent that it can destroy an individual's ability to enjoy life.

    National Institute on Drug Abuse, NIH, Dr. Nora D. Volkow M.D.

    A logical question would be why don't we just administer drugs to increase dopamine levels to help people beat depression since it seems to trigger such feelings of pleasure or euphoria? 

    Photo above: Brain activity of non-user versus user

    Actually it's been tried and found that increasing the levels of dopamine produces mania; just the opposite of manic depressives.  Patients are hard to manage in that they are very non-compliant with their meds.  They don't want to be leveled out, they want to stay high and experience the euphoria.

    Falling in love is an example of the intense high; some people have these areas stimulated by learning or taking courses or reading good books or the joy of experiencing nature.  We should not minimize the experience just because it is a chemical reaction.  Understanding how the brain works doesn't make the normal, pleasurable experience any less important.

    Drugs Effect on
    The Endogenous Reward System

    Substance abuse of drugs work at the cellular and molecular levels to highjack the endogenous reward system. All psycho active drugs operate on the limbic system and can be physiologically and psychologically addicting, driving the person to seek out the drug.

    There may be genetic factors at work as well.  Cocaine is highly addicting to most people but not so much to others.  Some can become dependent on drug but not physically addicted.  Females are more prone than males. 

    Clearly, there is a lot more research to be done in this whole area of substance abuse and why it hits some people harder than others.

    Cocaine and Marijuana

    Coke is a highly addictive psychostimulant that blocks the reuptake of serotonin and dopamine.  Its major targets are the projections to the frontal cortex area where it hits dopaminergic sites in the Nucleus accumbens septi and prefrontal cortex.

    Photo:  Coca plant (Erythroxylon Coca)

    Coca plant, Erythroxylon Coca

    All addictive drugs involve the nucleus accumbens septi.  Furthermore, the projection from ventral tegmental area to the NAS is believed to play a role in the behavior of addicts when seeking out a drug. 

    Coke blocks the reuptake of dopamine from cleft of synaptic terminals and without the reuptake; a lot of neurotransmitter is left in the cleft to keep stimulating.

    It throws off the workings of the synapse.  There is an initial intense stimulation providing elation, or the "high" as some call it.  

    The brain doesn't like it when the stimulation goes to the nucleus accumbens and prefrontal cortex so it compensates. The compensation takes the form of an intense "crash" characterized by depression, irritability, anxiety and lethargy. 

    The crash then promotes more craving and a need for higher doses of the drug to get the same effect since the synaptic receptors have also had their sensitivity downgraded.

    So what we end up with is a rapidly accelerating pattern of drug use and crack cocaine use shown in the photo below is one of the hardest of all to overcome.

    Woman smoking crack cocaine from glass pipe

    Long term use of coke may produce permanent changes in responsiveness of neurons in the reward system including a
    decreased responsiveness to dopamine and down regulation in the synthesis of opioids. 

    Over time we see an emotional blunting in the individual that contributes to recidivism since normal things in life that make us feel joy are gone.

    Giving up a drug can even trigger a grief response and cause a loss of appreciation for things that the person used to love.  Love of music or the arts or reading may no longer appeal to a recovered addict.

    Orbitofrontal area (OFA) of the brain is involved in impulse control, moral mores, and awareness of the consequences of one’s actions.  Thus, if the OFA is highjacked, we will see bizarre behaviors void of moral guidance.  A common example cited is a woman giving her 12 year old daughter to a drug dealer for one hit of coke.

    Cocaine is one thing...
    but pot's not so bad...is it?

    Marijuana or cannabis, in moderate doses, has effects similar to alcohol.  At higher doses it produces euphoria and heightened sensations which result in dependence in about 2/3 of pot smokers. This has been clinically demonstrated by inducing drug dependence in animals.

    Photo: Marijuana plant (Cannabis)

    Marijuana plant (Cannabis) from US Fish and Wildlife Department

    The same areas of the brain involved in cocaine use are involved with marijuana use, (VTA, NAS, PFC and hippocampus), but the effects of binding are very different than seen in blocking an uptake as in cocaine.

    As with cocaine, it binds to a specific receptor in the brain and alters the synapse but the binding results in different behavior. 

    Marijuana abuse manifests as a loss of motivation combined with memory problems. Chronic substance abuse will cause the neurons synapses to adapt to the presence of the drug in numerous ways.

    Drugs trigger a rapid increase in the concentration of neurotransmitters in the synapse cleft.  The synapse really doesn't like this so it compensates by reducing the number of receptors for the neurotransmitter.

    Another tactic the synapse might employ is to make the receptors less sensitive to the particular neurotransmitter, making it more difficult for the binding to occur.

    Both of these mechanisms are very common in chronic substance abusers, particularly alcohol, opiates, nicotine, and benzodiazepines (tranquilizers, valium for example).

    The end result is a tremendous increase in tolerance for the drug or alcohol or whatever.

    This tolerance isn't just limited to the brain.  For example, in alcoholics, the liver becomes able to metabolize more alcohol, thus reducing the amount that reaches the brain.  Can you say "Cirrhosis"?  Can you bear the cost of substance abuse?

    Because of the memory issues associated with marijuana, most research is focused on the binding of receptors in the hippocampus.  Any drug having a euphoric effect will stimulate the endogenous reward system.

    But whenever we have a receptor somewhere that binds cannabis, it doesn't mean that there are cannabis receptors in the brain. 

    What the brain has is receptors that have a naturally occurring molecule in the brain that binds to some endogenous receptor.  For example, the receptor that binds cannabis usually binds arachadonic acid, a fatty acid linked to inflammation, which has a structure similar to arachadonic acid.

    In the United States, billions of dollars have been spent on educating people on the dangers of smoking cigarettes but all of a sudden smoking pot is OK.  Several states have legalized marijuana and the Federal government seems to be tacitly approving its use.  It appears that too many of our legislators are operating under the effects of some strange substances.

    Alcohol...Number One Substance Abuse!

    Alcohol goes directly from the digestive tract into the blood vessels. In a matter of minutes, blood transports the alcohol to all parts of the body, including the brain where it affects the brain’s neurons in several ways.

    Photo:  Name your Poison...no shortage of choices

    Alcoholic beverages by Or17, 2/5/07

    It alters their membranes as well as their ion channels, enzymes, and receptors.

    Alcohol also binds directly to the receptors for acetylcholine, serotonin, Gamma-aminobutyric acid (GABA), and the N-methyl D-aspartate (NMDA) receptors for glutamate.

    GABA dampens the activity of neurons, making them less excitable, by allowing chloride ions to enter the post synaptic neuron (the receiving neuron). 

    When alcohol binds to the GABA receptor, it allows the ion channel to stay open longer, thus allowing more chloride ions to enter.  The neurons activity would be even further dampened which would explain the sedative effect of alcohol.

    This effect is even more accentuated when alcohol reduces glutamate’s excitatory effect on its NMDA receptors.

    However, chronic consumption of alcohol gradually makes the NMDA receptors hypersensitive to glutamate while desensitizing the GABAergic receptors. It is this sort of adaptation that would cause the state of excitation characteristic of alcohol withdrawal.

    Alcohol also helps to increase the release of dopamine, by a process that is still poorly understood but that appears to involve curtailing the activity of the enzyme that breaks dopamine down.

    Behavioral addictions such as sex, gambling, or aggressive violent behavior when viewed in functional MRI and PET scans show that same areas of brain light up as in drug addiction. 

    Neurologists still have a lot to learn about addiction, specifically why some never get addicted while some people take one drink and they're hooked.  When a substance abuser is not engaged in the activity, there is a huge motivation to take risks to find drug or engage in the euphoric activity. 

    More research needs to be done to understand how drugs affect the endogenous reward system in fetuses. Babies born to cocaine using mothers will be born with a cocaine addiction.  Babies born to alcoholic mothers are likely to be born with damaged brains, a condition known as fetal alcohol syndrome.

    I'm hooked!
    How do I kick this substance abuse?

    After wading through all that deep science and mind-numbing physiology, the only question now is..."If I, or someone I know, is hooked, how do we get off it? 

    I accept that the drugs and alcohol have rewired my brain and the craving is intense but is there any hope?  With regard to restoring the brains neurological connections to the way they were before the addiction took hold, we have a good news, bad news situation. 

    The good news is that a research team at the University of California studying the reversal of substance abuse has shown how blocking the flow of a specific chemical in the brain blocks the sensitization to a drug in lab rats. 

    Sensitization is what the researchers called the increasing levels of dependency and craving leading to addiction.  The problem here is that the chemical has to be blocked before a person starts on the drug; once addicted, it won't help or reverse the condition.

    Another group of researchers at the University of British Columbia in Vancouver has been working on ways to restore the brain connections that existed before the use of the addictive substance.  It seems to have worked in experiments with amphetamine addicted mice in which their addiction memory circuits apparently were rewired to erase the memory, and thus the craving, of the amphetamine.

    Now the bad news is that victims of substance abuse probably won't benefit from this research for at least 15 to 20 years.

    Yet millions of addicts have put all kinds of substance abuse behind them, but don't think it's easy or painless. 

    First of all there is likely to be an emotional adjustment; a period of deep depression brought on by a sense of loss.  An alcoholic or drug addict, having given up the substance of choice will often go through a very real grief response; much like losing a spouse or a long-time lover.

    Then there are the biological impacts of substance abuse to deal with and for these we will confine the discussion to alcohol. 

    Alcohol bypasses the normal digestive process and goes directly to the blood stream through the stomach wall and small intestine.  The alcohol hits every organ and tissue in the body within minutes after entering the blood stream.  The Blood-alcohol level is a measure of the amount of alcohol in the blood stream. 

    If someone has a blood-alcohol level of .03, it means that they have 3 parts alcohol per 10,000 parts blood. 

    Thirty parts alcohol per 10,000 parts blood is the minimum level that can cause death; Forty parts can cause coma; fifty parts and the respiratory and heart slows drastically and at 60 parts most people are dead; not dead drunk, just dead.  

    A long term alcoholic who wants to get sober for good will have a lot of systemic damage to deal with and will be faced with some serious rehab time to repair that damage. 

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    Starting with the liver, the body's greatest filter, a large amount of fat will have built up which may have brought on hepatitis (inflammation) or worse, cirrhosis of the liver.  All of this substance abuse will lead to a buildup of fats in the blood stream leading to cardiovascular problems.

    The brain suffers most with long term alcoholics.  The changes that substance abuse causes in the brain discussed above result in a tolerance for alcohol and a dependency on it. 

    Other noticeable signs of damage are loss of memory, confusion and extreme, rapid mood swings.  At least these can be controlled and even reversed by stopping the drinking.

    Tens of thousands of neurons will die with every episode of intoxication due to lack of oxygen usually accompanied by blackouts.

    Even blood is affected by chronic alcohol abuse.  Red blood cells tend to clump together causing small vessels to plug up, thus starving the tissues of oxygen resulting in cell death.  Obviously, this is most serious in the brain as mentioned above. 

    The increased pressure of plugged capillaries causes them to break resulting in the characteristic morning red eyes, blotchy skin on the alcoholics face and hemorrhaging in the stomach and esophagus.  Serious?  Yes, deadly serious.

    The pancreas is often damaged from substance abuse to the point of shutting down and ceasing to produce insulin.  This condition is purely from overwork where the pancreas is forced to produce an unnatural amount of insulin to deal with the high level of blood sugar that alcohol produces.  Diabetes is very common in alcoholics.

    Alcoholic’s muscles are typically weak and deteriorated due to reduced blood flow.  Since the heart is a muscle, a sluggish heart with irregular beats is common.

    Finally, in men we see some strange changes in sexual function from prolonged substance abuse, particularly with alcohol.  Alcohol sedates all the endocrine glands resulting in an under production of hormones which causes shrinkage of the testes and an increase in the female hormone estrogen. 

    If a guy wants enlarged breasts and loss of body hair, keep on chugging.  Sexual performance...forget it!  Where alcohol is concerned, substance abuse can decrease the frequency and quality of erections and that once powerful tool will become a "teeny-weeny". 

    Is that enough reasons not to become addicted to alcohol?

    Withdrawal from Alcohol Substance Abuse

    When we think of withdrawal, we usually think of hard drugs but going cold-turkey with alcohol has very definite and very unpleasant withdrawal stages.

    Withdrawal from those occasional periods of serious drinking or in people with only a mild dependency will include the familiar hangovers, sleep disturbances, possibly irritability and morning shakes. 

    More deeply dependent alcoholics will experience "second stage" withdrawal symptoms that may involve convulsions or seizures usually occurring from 12 to 48 hours from the last drink.  If the severity is extreme, loss of consciousness and body control may occur.

    What I call the down-in-the-gutter alcoholics will go through "third stage" withdrawal symptoms which are marked by hallucinations and delirium tremens or the DTs. 

    During de-tox, these can last three or four days, in which the person is in a severe state of agitation, sometimes violent, totally disoriented and can't sleep.  It is a terrifying experience and between 10% and 20% may not survive without close medical supervision.

    How do I Overcome
    Alcoholic Substance Abuse?

    There is no real secret of success or guarantees when trying to kick an alcohol addiction but sobriety time is the real measure of success.  Quitting smoking is easy; I know, I quit a thousand times.  With many substance abusers, it’s the same story.

    Many drift in and out of rehab, in and out of recovery, getting a little taste of how good life can be, and then slipping back into addiction.  Why? 

    Let’s look at the nutritional considerations of substance abuse first then move to the more subjective areas of desire, emotional state, willpower and support groups.

    Heavy chronic drinkers will be severely depleted of micro nutrients so diet and supplementation become critical.

    Start with an increase in protein intake.  Adjusting the diet to include high amounts of protein will replace many missing nutrients and, more importantly, keep the blood sugar from changing too rapidly. 

    The caution here is to get those proteins from eggs, milk, vegetables and soy products instead of meat and cheese.  The alcoholic liver will be full of fatty deposits and will not be able to process the extra fat from meat or cheese.  When eating meat, fruit should be eaten with it to help break down those additional fats.

    Vitamin and protein supplementation are important, especially vitamins A, B, C and E.  The protein supplementation will help reduce the alcohol craving and aid in maintaining emotional balance. 

    The inclusion of complex carbohydrates can stabilize the blood sugar and alleviate the hypoglycemic (low blood sugar) state of the alcoholic and also help reduce the craving.

    Now for the intangibles.

    All we can do is examine the common characteristics of those addicts that have achieved long term sobriety and see how they did it. 

    We've heard that someone has to "hit bottom" before they can really come to terms with their substance abuse.  It's not the hitting bottom that is significant, it's being able to admit complete defeat against drugs or alcohol and accepting the need for a change. 

    No one in the state of denial ever made a long term recovery.  This can be summed up as a state of complete surrender.

    Those alcoholics who have achieved long term sobriety in Alcoholics Anonymous usually tell how deeply involved they were in the recovery program.  It's hard to achieve any level of success by dabbling in a recovery program. 

    Dabbling is not evidence of commitment and total commitment is what is required; it's an outward show what is driving a person towards a lifestyle of sobriety.

    A driving level of desperation is needed to get someone struggling with substance abuse to follow directions given that any recovery program is mainly a set of directions leading to a drug free or alcohol free life. 

    Successful AA followers often share in meetings how they were willing to do whatever was asked of them in order to stay sober.

    There are a number of mind adjustments that can help stay the course for the long haul.  Great journeys are made one step at a time so instead of steps, focus on one day at a time.  Don't look at the coming year or coming month or even a week; just get through today.  Get through today and tomorrow will be a new fresh start.

    Short term treatments are not likely to do a hard-core substance abusers much good no matter what the level of commitment.  There are just too many habits that need to be changed and new lifestyle attitudes to develop. 

    Anyone with a chronic alcohol addiction should seek out a long term treatment center, facility or home.  It will take a year or
    more to build a foundation for recovery and long term is the only approach.

    The real key for a totally addicted alcoholic to find and live a life of sobriety is to find one's spirit.  Having a spiritual awakening is not the same as a religious conversion. 

    For the substance abuser it means overcoming "self", putting self-centeredness behind and going through a change in psyche.  Training in behavioral approaches and cognitive therapies are good but only go so far.  Real success lies in that psychic change in personality and constantly reinforcing it by helping others in recovery.

    Learning to keep balance in one’s life is another vital factor in the long road to sobriety.  Too many recovering addicts trade one addiction for another such as swapping alcoholism for workaholism. 

    Willingness to change is present in the early stages of recovery but it must be maintained.  It is usually done by trying new ideas, being open to criticism and overcoming fears. 

    Avoid standing still.  The recovering alcoholic is either growing or regressing.  There is no standing still. 

    Those who achieve long term sobriety are constantly finding ways to grow spiritually, pushing themselves to grow spiritually.

    And finally, don't go it alone.  Remember "No Man Is An Island"?  Everyone struggling with substance abuse needs the help of others or a support group to succeed long term whether it's 12-step meetings, therapy, counseling or anything else that brings one into contact with a network.

    Hit The Books...The Top Ten
    Recovery Books on Substance Abuse

    Over the years thousands of books have been written on how to live with, deal with and recover from alcoholism and other types of substance abuse.  According the the New York Times, the following are the top ten.  You can click on the links shown beside each book to check prices and place an order from Amazon.

    The first is a real classic from 1938 titled "Alcoholics Anonymous" which delves into the 12-step recovery program.

    Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism

    Second on the list is "Adult Children of Alcoholics" by Janet Woititz.  It deals with problems experienced by people who grew up in an alcoholic home environment.

    Adult Children of Alcoholics

    Third is the landmark book, "Codependent No More and Beyond Codependency" by Melody Beattie.  They started out as two volumes and have now been combined into one book.  

    Codependent No More & Beyond Codependency

    Fourth is "Love is a Choice" by Minirth, Meier Hemfelt.  It covers the causes of codependency and shows how God's love is an essential part of the healing process.

    Love Is a Choice: The Definitive Book on Letting Go of Unhealthy Relationships

    Fifth is "one Day at a Time in Al-Anon", a daily reader full of inspirational messages on Al-Anon's philosophy for everyday situations.

    One Day at a Time in Al-Anon

    Sixth is "Serenity" by Robert Hemfelt.  It is a companion to the 12-step process and includes the New Testament, Psalms and Proverbs.

    Serenity: A Companion for Twelve Step Recovery

    Seventh is "The Dilema of the Alcoholic Marriage" from the Al-Anon Family Group.

    The Dilemma of the Alcoholic Marriage

    Eighth is M. Scott Peck's 25-year best seller, "The Road Less Traveled";  A classic on traditional values and spiritual growth.

    The Road Less Traveled, 25th Anniversary Edition: A New Psychology of Love, Traditional Values, and Spiritual Growth

    Ninth is "A Spiritual Kindergarten: Christian Perspectives on the Twelve Steps" by Dale Ryan.  It looks at why the 12-steps are just a starting point. 

    A Spiritual Kindergarten: Christian Perspectives On The Twelve Steps

    Last but not least is "Under the Influence" by Dr. James Milam and Katherine Ketcham.  It is a guide to the myths and realities of alcoholism.

    Under the Influence: A Guide to the Myths and Realities of Alcoholism


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