It is my belief that escape is at the heart of all addiction. Brene Brown points out in her book "Daring Greatly," shame and guilt are fostered by our attempts to escape our feelings. She identifies three primary ways of escaping feelings.
One of the problems that I see frequently is patients with cross addiction, specifically those who are also being given “legitimate” prescription medications such as stimulants, benzodiazepines, opiates for bona fide symptoms.
These people are demanding, hard on themselves and others, constant life crises. The chaos leads to shame and lack of self-worth even though the person may be very intelligent or accomplished. They engage in a lot of helplessness, frequently asking for help but not carrying through with moving to a conclusion.
The answer is not whether to provide adequate pain relief. That is a given. There is no reason that anyone with addiction should be made to suffer needlessly. If we know that someone is going to suffer post-surgical pain or a similar level of pain for other reasons, the patient with addiction should be treated as one would treat anyone.
What is happening in the brain is the building of receptors that have to be filled with alcohol or drugs to achieve a calm state. So tolerance develops and one needs more and more alcohol or benzodiazepines or nicotine to calm the individual. As more and more receptors build in the brain, more drugs, alcohol and nicotine is needed to bring the person to a state of calm.
Untangling the triangles of addicted families can be a full-time job. Since one grows up in a family with a history and a present reality, as a child, one’s major frame of reference is the family constellation and the culture that goes along with it.
So the opiate problem is not solved. There is no perfect drug or therapy, but it is still a certainty that the use of street heroin or synthetic opiates is extremely lethal... So the opiate problem is not solved. There is no perfect drug or therapy, but it is still a certainty that the use of street heroin or synthetic opiates is extremely lethal.
After The Harrison Act was ratified, it was the beginning of the DEA and the “Controlled Substances” legislations. Again, although well meaning, this effectively drove addicted patients underground, and the black market for opiates began.
One of the more controversial issues in addiction medicine is the practice of opiate replacement therapy, or ORT. It is important to understand the history of ORT if we are to begin to understand how it should or should not be used.
Understanding automatic behavior allows us to surrender to what we cannot control. It frees us to do the next right thing by staying in the present rather than worrying about the future or being shamed and experience guilt about the past. It takes practice.
Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.
About Where Addiction Meets Your Brain
This blog is intended to discuss the psychological and behavioral aspects of addiction. Addiction is a disease (dysregulation) of parts of the limbic system of the brain. This dysregulation of dopamine and other neurochemicals creates a pattern of compulsive use of substances. This compulsion and the mood alterations that accompany the use of addictive substances leads to behaviors and consequences that are almost always negative for the individual and those around them. Historically, addiction is viewed pejoratively by society. In fact, it is an illness that requires treatment.