Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: anxiety

Why People With Addiction Act Like “Crazy” Teenagers.

Anthony Michael Hall, aka "The Brain," toking away in the school library in "The Breakfast Club."

Anthony Michael Hall, aka “The Brain,” toking away in the school library in “The Breakfast Club.”

So I’ve taken rather a long hiatus from this site so I could focus on finishing a book. To those who have waited patiently with me, thank you. And now that that project is in production—the book will be out in October!—I’m starting to ramp back up here and in other places.

One of those places is Addiction Treatment Magazine. These folks found this blog and asked me to run some story ideas by them. Recently the New York Times ran an op-ed by a Weill Cornell Medical College psychiatrist about “Why Teenagers Act Crazy.” The psychiatrist described how, during adolescence, the part of the brain called the amygdala grows much faster than the part called the prefrontal cortex, and this is the cause of teenagers’ anxiety and compromised ability, under stress, to make wise decisions.

While writing this book I learned all about the amygdala and the prefrontal cortex, which some doctors and researchers call the “PFC.” The amygdala is the seat of the memory and emotional responses, and a part of what’s often called the “midbrain” or “limbic system.” It’s a very evolutionarily old part of the brain, and as such it sits deep inside the brain, at the top of the spinal column and the spinal cord.

The PFC evolved later in human evolution, and because of this it’s located on the outer part of the brain, in the front of the skull. It’s the center of what researchers call “executive function”—decision-making based on values, principles, reason.

What taught me all this? Lots of reading and several people, most particularly Kevin McCauley, M.D., director of program services at New Roads Treatment Center in Sandy, Utah. McCauley is a former Naval pilot and flight surgeon who, many years back, became addicted to dilaudid while on the job. He hid his addiction for a while, then eventually the Navy discovered it and, instead of sending him to treatment, sent him for a year to Leavenworth prison. He used his time inside to read as much as he could about the physiology of addiction. And what he found out was that drugs hijack the midbrain and move straight to the top of its priority list. The midbrain, McCauley says, is the part that “gets us through the next fifteen minutes alive”: it protects our ability to eat, fight, and reproduce. So when we’re addicted, instead of enacting these survival skills, our hijacked midbrains tell us we need drugs before we need anything else.

To boot, addiction short-circuits the communication link between the prefrontal cortex and the midbrain. So not only do drugs move to the top of the list of the hijacked midbrain, but also the PFC can’t override the hijacker because it’s bound and gagged.

(If you want to hear McCauley talk about the theory of Addiction As A Disease that he developed while he was in prison, start with this YouTube video, then visit his site and snag his DVD called Pleasure Unwoven.)

When I read the NYT piece, bells went off in my head. Being the mom of an almost-17-year-old young man, I realized in the same moment:

  • He gets mouthy and anxious and hungry (and probably horny, but I don’t know about that) because his PFC isn’t done growing; and
  • People in active addiction are basically like teenagers. They can never get enough of anything, and they want it NOW.

The only advice the writer of the NYT piece had about how to handle teens’ “craziness” was this: We parents just have to tell them to be patient, they’ll grow out of it. This kind of bugged some readers, and in the comments section they were like, Can’t you do any better than that? 

I can do better than that. To hear my suggestions about how to talk to teens, both about their anxiety and about addiction, read the full piece.

Motherhood and My Addiction: By Guest Poster Tara

Guest poster Tara, who blogs about sobriety at The Act of Returning to Normal, writes today about how her alcoholism and her motherhood were intertwined—she drank to soothe her fears that she wasn’t a “good-enough mother”… and, later, she got sober in part out of her desire to give her kids a sober mom. I’m grateful to Tara for this post—I so closely identify with her feelings about motherhood: intimidation; inferiority; setting up the goal of perfection, and never being able to meet it.

Tara, I’m so glad you’re sober today. 🙂 Happy Mother’s Day.

Readers interested in guest-posting can email me at guinevere (at) guineveregetssober (dot) com.

***

Motherhood and My Addiction

by Tara

Drinking motherDuring the last few months of my drinking in the summer of 2010, I was in a serious funk. Believing that my problem was a depression that had nothing to do with the copious amounts of alcohol I consumed, I considered going to my doctor to ask for anti-depressants. The part of me that was concerned about my drinking was also convinced that if I wasn’t suffering from depression, I would definitely have to cut back. I couldn’t contemplate quitting altogether, largely because it seemed impossible, like running a marathon. So I pondered anti-depressants, but procrastinated about making a plan to take them. Part of me was afraid I would never be able to drink normally, even if I did feel better.

It was summer and I was working from home. My kids were at summer day camp. I drank vodka at lunch every day. Cautious about consuming too much, I measured the portions carefully, stopping after lunch so that I wouldn’t be too drunk to drive to camp to pick them up. Each morning I promised myself that I wouldn’t drink until after they got home. By lunch each day I broke my promise. Later, I would thank God that I had this one small responsibility. I think it was the only thing that prevented a complete downward spiral into absolute drunkenness. I believe if not for that one ten-minute drive each day that I would have started drinking after breakfast.

The weekends were a different story. It was during this summer, on the weekends, that I began drinking before lunch while my family was out grocery shopping and I was home alone cleaning up the house. Looking back, I’m not sure why drinking in the mornings seemed necessary, but I wanted solace from an anxiety I couldn’t shake. I wanted to recapture the wake-and-bake feelings I had in my early twenties—that feeling that all was well with the world. Back then, I lived in San Francisco and smoked pot all the time; then, it seemed okay to chase peak experiences because it aligned with my desire to be more laid back, more “Californian.” I was trying to change myself the only way I knew how, from the outside in, and saw smoking pot as a style choice, on a par with wearing bell-bottomed pants and listening to folk music. I stopped smoking pot in 2001 when I was pregnant with my first child. At the same time, I put away my bell-bottoms. In my mind, getting high was tied to youthful exploration and at odds with my new sense of responsibility to my daughter. It was easy to let it go.

Ten years later it seemed I still wanted the hard edges of life to melt away so that I could be left with a good feeling. I wanted to be there for my kids but I felt like I wasn’t good enough as I was. In order to be a good mother, I believed I had to reshape myself into someone who loved them enough to help them, to listen to their stories, and to automatically have all of the right answers. I wanted to give them a sense of self-confidence and well-being my parents hadn’t given me. When I was drunk—just enough—I thought the “bad mother” parts of me moved into the shadows. I thought that I had to feel good to be a good mother. I thought that to feel bad meant I was bad.

There were many tangible moments that underlined my sense of failure at motherhood: “forgetting” to sign up for sports because practice was scheduled for times I typically drank, and hurrying along the bedtime routine because I needed to get back to my glass. I’m also sure there were embarrassing moments I don’t remember: slurred words,  stumbling, and forgetfulness. I loved my kids more than anything else, but I couldn’t fully accept that my drinking prevented me from connecting deeply with them.

Then two things happened that finally led me to seek sobriety. First, in a fit of pain over my failures in parenting, I tried to hurt myself. I don’t say kill, because I don’t think that was my intention at the time, although clearly it could have been a consequence. Second, my mother-in-law lost her temper because she saw everyone in the house tiptoeing around, pretending we were fine. She now admits that it drove her crazy to be with us, because although she couldn’t put her finger on why, she knew things were not good. Her anger wasn’t specifically directed at my drinking, even though she definitely thought I drank too much and saw through the lies I told her about cutting back. She knew that my life was unmanageable even though she didn’t know the truth about when or how much I drank.

After going through these two things, I was finally able to accept that things were not “fine.” I understood I had lost myself completely and I would never get out of the mess I was in—unless I first stopped drinking. This comprehension humbled me and for the first time in over ten years I asked to be released from my addiction. I prayed every day and counted the minutes. It sounds simplistic, even now, but for the first time in years I was able to put more than one or two days of sobriety together. This simple prayer worked for a few weeks, until I realized I needed help if I were going to put any amount of time together. I found AA and it helps me to stay sober.

After months of drunken contemplation about whether my family would be better off without me, when I got sober I understood the pain my kids would feel if I just disappeared. My memories of the night I tried to hurt myself, and the scars on the inside of my wrist, keep me focused on the fact that no matter how shitty things may seem now, they were truly shitty when I was drinking.

The Dutch Begin Studying Baclofen For Addiction

So here we are again, back at the baclofen question. My Dutch friend sends me a link to a news story (in Dutch!) about the University of Amsterdam starting a study of baclofen as a treatment for alcoholism and drug addiction. Managed to cobble some sense out of the story, which begins:

Is this the wonder pill which will bring rescue to, among others, alcoholics, junkies and smoke-drug addicts?

“Smoke-drug addicts”—very much like that one. My mother, a die-hard smoker for 30 years before she died at 58 of lung cancer, was definitely a “smoke-drug addict.”

(Another interesting tidbit: the Dutch word for “addiction” is “verslaving”—which, my friend says, means “a slave to a substance.”)

Baclofen is a derivative of gamma-aminobutyric acid (GABA) and is a GABA-receptor agonist—just like, as it happens, alcohol. Surprise, surprise! they work in the same way. … Baclofen is prescribed as a muscle-relaxant for spasticity in conditions such as multiple sclerosis. It is also prescribed off-label to reduce addictive cravings. And it’s dependency-producing. You can’t just quit baclofen—it must be tapered up and down when getting on or off it; stopping use suddenly leads to the same kind of (prolonged, painful) detox that benzos induce.

So they’re gonna study us alcoholics, junkies and smokers, BUT: not gamblers, because apparently there’s no medical evidence that gambling addiction actually exists. The researchers are, according to the story, somehow really hoping it works for drug-addicts. Leading us to believe “junkies” are maybe worse than the other types?

The story quotes a guy from a drug-rehab who has administered baclofen to 100 patients addicted to alcohol, cocaine, cannabis, GHB and benzos, and, apparently, about half of them no longer use their (other) drugs.

The best part of the story: the researchers are speculating that baclofen works better on addicts who use out of “angst.” The story reads (according to my Dutch friend–thanks P):

“With people who use substances from a more positive emotion we do not believe baclofen to be very effective,” according to [Professor Reinout] Wiers [of Amsterdam University]. One assumption of the researchers is that the muscle relaxer also has a calming effect on addicts who try to mask and conquer their fear.

Which would make sense. I mean, what real alcoholic doesn’t drink out of conscious or unconscious “angst”?

Also: I was not fully aware of this, but angst is the Germanic word for fear. So, take a pill, and my fear is relieved. … This brought back the words of my first sponsor, a deeply spiritual woman and former “junkie” who once advised me, as I detoxed off fentanyl and started work on my Fourth Step only to discover that I had a few bits of “angst” going on:

DON’T call it “anxiety.” It’s plain old fuckin fear, OK? If you call it “anxiety,” you can go to the doctor and get a pill for it. It’s OK to medicate “anxiety.” But nobody goes to the doctor and says, “I’m having some FEAR, I need a pill.”

I took her point.

But maybe now, with baclofen, you’ll be able to do that.

Olivier Amiesen, M.D., who controls his alcoholic cravings with Baclofen

The whole baclofen business started with Olivier Ameisen, a French cardiologist who for 15 years practiced in New York and taught medicine at Cornell’s Weill Medical College. Unable to stay sober despite following up on all his practitioners’ recommendations, going to rehab, and sitting in two AA meetings per day for seven years, Ameisen experimented on himself: he started taking high doses of baclofen, which, he wrote in his 2008 book The End of My Addiction, eradicated his cravings and allowed him to become a social drinker. Ameisen called for randomized studies of baclofen’s effectiveness—of which, presumably, the Amsterdam study is one.

One wonders if it would even be OK to become a social drinker while taking high-dose baclofen. Though not classified as a benzo, baclofen basically has a benzo profile and the same kinds of OD risks. In addition, though it seems not to have any tolerance effect (unlike alcohol), dosages have to be closely monitored, because over 80mg/day baclofen can interfere with functioning and cause drowsiness. Ameisen uses baclofen at doses of 200mg+.

I once brought my questions about baclofen up at a meeting early in my sobriety. I got a number of very interesting responses. One was from a young man, maybe 28 or 29, who had been clean for about a year or so. Smart guy and very physically fit. His face lit up like a torch when I mentioned baclofen. After the meeting he said:

It’s funny when people talk about using baclofen to get rid of cravings. My experience was, when I used baclofen WITH alcohol, the combination was juuuuust right. If you know what I mean.

I knew what he meant.

For me, using a chemical to fight chemical addiction is like using water to avert a flood.

Ameisen’s statistic sounds so disappointing: 5,000 meetings over seven years failed to keep him sober. Another friend, a former heroin addict who got sober the way I did, bristled when I mentioned this statistic:

For an addict like me, sitting in two AA meetings per day for seven years ISN’T the solution.

What this person meant was, for an addict like her, the solution = taking the steps. Meetings alone don’t keep her sober.

I can buy, along with Gabor Maté (one of my true addiction-treatment heroes), that some people just can’t get sober with the steps and may need to take “maintenance” drugs to escape the “junkie” lifestyle. That’s cool. In Stephen King’s words, there’s more than one way to de-fur a feline. But if they want to research the addiction-treatment possibilities of baclofen, on which the patent has expired and from which ain’t nobody gonna make no big bucks, why don’t they also research the effectiveness of other cheap and non-patentable “solutions” that have worked for millions of people for much longer?

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