Some people go to AA or NA for the rest of their lives. Others go for years before deciding that they have their addiction under control so they stop, and many end up using again. It’s like chemotherapy for cancer. AA/NA is like their medication, their chemotherapy. If they don’t go, they often relapse, maybe not right away, but later if not sooner.
Even when addicts achieve stable abstinence and have time in recovery, they remain at risk. Research has shown that significant changes in brain functioning can persist long after drug use stops. In other words, the brain is not the same as it was, which is why addicts can go through a detox program, and then go on to complete treatment, remain abstinent as years go by, and then decide they can drink again. Within a very short period of time, they end up right back where they were when they stopped. This is evidence of disease progression. The brain is the same addictive brain—once “pickled” it is always “pickled,” and that pump is permanently primed. The first subsequent use of alcohol or other drugs can trigger a rapid return to active addiction.
The progressive loss of control that occurs in addiction is a very real, palpable phenomenon that does not differentiate based on financial status, job, race, religion, or gender. You can have a captain of industry, like someone who runs a Fortune 500 company, who went to Yale or Harvard, or is a senator, or a professional athlete who is brought to his or her knees by addiction. These are people who have been in control of everything around them for most of their lives. They may have millions of dollars and live in luxury homes in the most desirable, upscale communities, but then somebody introduces them to an addictive substance such as prescription opioids, cocaine, or crystal meth, or they get increasingly caught up in using whatever it is they can’t control. The more willpower they try to use, the harder they work to control it, the more they end up losing control.
They can’t control it because attempts to control behavior use the thinking part of the brain, the prefrontal cortex, as addicts try to think their way out of addiction. But thinking one’s way out of addiction is not possible because drugs of abuse target the midbrain (the so-called reptilian brain, below the cortex, which operates at a level beneath conscious thought). As a result, a different approach is required.
Sometimes patients will arrive and explain that they have their own ideas of what will work for them, and if it (whatever configuration of appropriate treatment, mutual aid/support group involvement or medication they may have in mind) does work for them, that’s fine. The problem I have is when patients come in and say, “I don’t want to go to AA/NA. I don’t want to go to the rehab program. I don’t have to see a therapist. Just detox me and let me go.” I say, “That probably isn’t going to work. You’re probably going to be right back here again in a month or two.” And their response is “Oh, no, I’m going to be fine.” And then they’re back again two or three months later, and this will go on and on.
Then there are the patients who are taking medications and they stop taking them because they think that the medication that they’re taking to help with their addiction is having an adverse side effect. One thing you learn in medicine, and it’s not just with addiction medications, it’s with any medication, is that with some people the medication is going to work effectively while others are going to get hives, a rash, or vomit. In short, they can’t tolerate the medication. Whether it’s an addiction-related medication, a blood pressure pill, or a diabetic medication, there is a lot of trial and error involved in what we refer to as empirical treatment. You have to try this and you have to try that in order to find out what works for each patient.
One of the problems practitioners encounter is that people now hear about many medications due to the hype of pharmaceutical company advertising and the promises made on TV commercials, and they think that’s the solution to their problem. Just take a pill and that will “solve my depression.” People often learn the hard way that there’s a lot more to getting through depression than just taking a pill. No two patients are the same; everybody’s an individual, so you have to do a comprehensive assessment to see what methodology can best be utilized with that client to help them with their recovery from depression.
While there are a lot of different drugs out there, you don’t have to be an expert on every single one of them because basically there are just five classes of mind-altering drugs. So whether you’re a counselor, a physician, nurse, or therapist, when you’re dealing with substance problems, you are always dealing with five classes of chemicals. The five classes of drugs all exhibit different effects. What they all have in common is that they stimulate the reward/pleasure center of the brain. They are
People often ask me, “Isn’t marijuana a harmless drug?” My answer is that anytime you smoke something, it’s harmful. When you inhale smoke, whether it’s tobacco smoke or marijuana smoke, inhaling heated smoke is inherently unhealthy.
In addition, since, along with alcohol, marijuana is often a so-called gateway drug that people begin using in adolescence or even in latency age, we must ask ourselves how marijuana affects kids’ development. We know that the marijuana being used today is many times more potent than it was in the sixties and seventies.
We used to believe that the human brain was structurally complete at birth, that it had all of the neurons it would ever have, and that while these brain cells could die through damage or aging, more could never be added. We know now that the human brain is not fully formed until people are in their mid-twenties, and that it can continue to grow, evolve, and add neurons throughout one’s lifespan. The question is, exactly what is in the high-dose cannabinoids that contemporary, highly potent marijuana contains? We really don’t know what kind of negative impact these chemicals have on growing brains. We know that it leads to amotivational syndrome where users don’t feel like doing much of anything, whether going to school, doing schoolwork, doing chores, going to work, or taking care of other responsibilities. From a research perspective related to marijuana, one of the most important issues is to understand the vulnerability of young, developing brains to cannabis.
So despite the public’s perception that marijuana is relatively harmless, the numbers clearly tell us that it is an addictive drug. I tell people who don’t believe marijuana is addictive to go to a Marijuana Anonymous meeting, where they will see and hear people whose lives have been ruined by marijuana. There is no question that marijuana can be addictive.