Alcoholism

Uncovering Hidden Addictions

Identifying signs and symptoms of drug and alcohol addiction.

Posted Aug 19, 2009

In today's entry, in light of the tragic story about Diane Schuler (who crashed going the wrong way down the Taconic Parkway killing eight), I wanted to discuss the topic of "Hidden Addictions." Obviously, with such a public tragedy, a great deal of anger and frustration is aimed at the late Ms. Schuler. However, like most tragedies, we as a society, if we are smart, can take the tragedy, learn from it and make changes to improve ourselves so that something good can actually come out of it. I hope that this blog can be a bright spot of hope and an impetus to change by conveying accurate information about identifying signs and symptoms of addiction.

So many people are thinking about the fact that Ms. Schuler had such a high alcohol level in her body (the equivalent to 10 drinks) with even more in her stomach waiting to go into the bloodstream. On top of that, reports indicate that she was smoking marijuana within 15-60 minutes of the accident. How could her husband or other family members not know that she had a problem, much less let her drive with 3 small kids in the car? This is a very reasonable question to ask. Was she really and truly hiding all of her substance use from her family? We may never know the answers to these questions specifically for the Schuler family, however, here are some of my thoughts on the subject of Hidden Addiction:

  1. No one ever thinks that they will become addicted or that it will happen to someone in their family, but it does. If someone is struggling with increased stress at home, work, marriage, you should just raise your awareness that developing an alcohol or drug addiction is a possibility about 7% of the time. If you do notice these symptoms, talk about them with the individual and ask for help from your doctor or information from other reliable addiction-focused resources such as www.enterhealth.com or www.drugfree.org. 
  2. "Hidden Addictions" are not that common in general in that alcohol and drugs injure the brain and eventually the addict will "slip up" and show signs of their illness (they are not "hidden" any more). Therefore, in many cases you should be able to see some signs of this chronic medical disease of the brain (yes alcohol and drug addiction are chronic brain diseases - for more information see my 8/3/09 post on this site or my book Healing the Addicted Brain, www.enterhealth.com/healingtheaddictedbrain).
  3. At the same time, the alcoholic or drug addict will often work hard at masking the problem and staying undetected, especially in the earlier phases of the illness. 
  4. The good news is that, while alcohol and drug addiction is a chronic medical illness of the brain, it is treatable. The bad news is that it can't get treated until it gets recognized, and usually the addict is the last one to know about the addiction because they are in denial and their brain is injured. Everyone else often knows about the addiction from the very obvious symptoms. 
  5. Still another complicating factor is that all alcohol and drug addictions, including "hidden addictions" usually develop slowly, so at times they can be hard to notice. In other words, the frequency of alcohol/drug use, or more likely some combination of the two, can really "sneak up" on you and your family. 
  6. The specific symptoms of a "hidden addiction" vary depending on the substance used. For instance:
    • Alcohol - slurred speech, skin turning yellow from liver problems
    • Stimulants - paranoia, skin lesions
    • Marijuana - burns on fingers
    • Narcotics - constipation, excessive sedation
  7. However there are very common symptoms which do occur across all substance classes:
    • Memory problems - in the extreme these can present as "blackouts" - where the person does not remember parts of or all of the night before.
    • Changes in sleep patterns
    • Irritability, agitation and anger
    • Unresponsiveness - looking "spaced out"
    • Rapid weight loss or change in eating habits
    • Thinking problems in general 
      • Making more mistakes than normal
      • Making "bad" decisions
      • Using "bad" judgment
    • Becoming more socially distant and isolated in many areas of life.
  • Alcohol - slurred speech, skin turning yellow from liver problems
  • Stimulants - paranoia, skin lesions
  • Marijuana - burns on fingers
  • Narcotics - constipation, excessive sedation
  • Memory problems - in the extreme these can present as "blackouts" - where the person does not remember parts of or all of the night before.
  • Changes in sleep patterns
  • Irritability, agitation and anger
  • Unresponsiveness - looking "spaced out"
  • Rapid weight loss or change in eating habits
  • Thinking problems in general 
    • Making more mistakes than normal
    • Making "bad" decisions
    • Using "bad" judgment
  • Becoming more socially distant and isolated in many areas of life.
  • Making more mistakes than normal
  • Making "bad" decisions
  • Using "bad" judgment

Now let's look at three drug classes more specifically - alcohol, methamphetamine and cocaine - in terms of types of behaviors and symptoms that you might be able to notice as a friend or a family member (note: I would like to mention that Larry Hanselka, PhD, made a significant contribution to the following three categories):

Alcohol:

Some typical alcoholic behaviors may include the following:

  1. One characteristic of alcoholic behavior is that drinking becomes the primary response for dealing with stress from work, relationships, making decisions and inner pressure. When people don't have an alcohol addiction and the pressure builds up there is still a need to clear one's head. However, they will use healthy coping behaviors such as going to the gym, taking a car ride, running or going to the movies. These "stress management" skills lead the individual in a positive direction. On the other hand, with a growing alcohol addiction, the person doesn't find enough relief in the above healthy, stress relieving activities, but instead turns to alcohol as a way to forget the inner pressures (albeit temporarily). The more socially acceptable, healthy forms of release just don't do it for the person. 
  2. If a drink isn't available, classic alcoholic behaviors include getting extremely irritable and developing a short fuse because alcohol can't be consumed right away. Furthermore, instead of communicating about issues, denial and blaming others becomes the approach of choice. 
  3. As the drinking increases, there is a need for more alcohol to achieve the same effect due to building up a higher tolerance. Many think they can be a functioning alcoholic and attend work, go to their kids' sports games, etc., while drinking, but often the dependency on alcohol increases and starts to tear apart one's life.
  4. Health problems can grow due to the fact that alcohol addiction often includes poor attention to nutrition and one's meals. At this point, the alcohol's effects on the body can become even more noticeable and can manifest as hand tremors, stomach problems or blackouts. 
  5. Alcoholic behaviors develop into being late for work, not meeting deadlines, poor concentration and less involvement with the family. A lot of rationalization (part of the denial process) by the alcoholic may occur by them saying that having a few drinks is "common" and that "many people drink that much." In an effort to avoid any admission of a problem, eye contact is often lessened, as well as genuine dialogues with friends and family members.
  6. When the disease of alcoholism really mushrooms, there can be significant financial issues, drinking during the day, job loss and even the breakup of one's family and close relationships. Shakes and severe withdrawals can occur as well as hallucinations and paranoia.

Methamphetamine (belongs to the stimulant class of substances):

Recognizing signs of methamphetamine (meth) addiction:

  1. An addiction to meth is very visible. The user's outward appearance changes rapidly. The drug causes blood vessels to constrict, cutting down the steady flow of blood to many important areas of the body causing the body to deteriorate. The skin loses its luster. Acne appears, causing the addict to "pick" at their skin repetitively until a condition called "scabbing" is achieved. Scabbing can also be caused as the drug addiction produces the sensation of bugs crawling under the skin. The user may spend hours trying to remove these "bugs" - literally tearing their skin off.
  2. Excessive energy level: Crystal meth stimulates a person's energy level to such a degree that combined with its ability to suppress appetite, you will sometimes see the meth use start as a "tool" to control weight. The user, feeling more confident and attractive than ever before, is blinded to what is really in the mirror. Therefore, rapid weight loss can be a "signaling" symptom that you may want to start investigating. 
  3. Meth causes the salivary glands to dry out. The acid in the mouth literally attacks the enamel on the teeth causing cavities and making the teeth very soft and susceptible to damage. This condition is commonly called "Meth Mouth."
  4. The meth abuser does not sleep for days on end. These highs are then followed by periods of excessive sleepiness and ravenous appetites upon awakening.
  5. Meth activates your adrenalin system (fight or flight mechanism), which is intense, resulting in irrational behavior that often leads to violence. 
  6. The ability to consider consequences or judge actions is lost, leading the addict to act and react in ways one would not think possible - using extremely poor judgment.
  7. Meth is very detrimental to the brain's overall functioning - concentration, memory, abstract thinking and planning can all be effected.
  8. Hallucinations are common, as is a significant paranoia that only worsens over time.


Cocaine (belongs to the stimulant class of substances):

How to spot someone with a cocaine addiction:

  1. Those using cocaine experience a significant euphoric rush when the drug kicks in. This can lead to episodes of manic energy where the person talks very fast and experiences moments of grandiose thinking. 
  2. The individual is prone to getting nosebleeds (a classic symptom of cocaine use). This occurs because the cocaine destroys the membranes inside the nose, causing the nose to bleed. Stuffy and runny noses are also common nasal symptoms associated with cocaine use. 
  3. The individual has a tendency to "crash". After long cocaine binges, users are known to become listless and have very low energy. Many people will sleep excessively for days after using large amounts of cocaine over an extended period of time. Also, like with meth, when they wake up they can have ravenous appetites.
  4. The individual has sudden financial problems. Cocaine is an expensive drug, and many people will "burn" through all their money, including their life savings, to pay for their habit. Watch for people who want to borrow money or offer to sell their possessions at a greatly discounted rate.
  5. The individual forgoes old friends and begins to run with a different crowd. Those addicted to cocaine will likely begin to hang out with other drug users. Simply put, these new "friends" act as co-dependants, never asking too many questions or looking down upon the individual because of their addiction. Even the most solid friendships will be tested when one of the parties is a user (this symptom can be seen in all classes of drug use.)
  6. The individual experiences paranoia or panic attacks. Cocaine alters the brain, and can cause a variety of psychological symptoms, including thoughts that "everyone is out to get me" or "the walls are closing in around me". Chest pains and heavy sweating may also accompany these symptoms. Cocaine users may feel nervous or anxious in normal social settings.
  7. The individual suffers at work and loses interest in friends and family. Cocaine overtakes the life of the addict. As such, all the things that used to be important to the individual now take a back seat to the drug. People addicted to cocaine will lose their good-standing at work, hurt the people closest to them, and let hobbies and activities fall by the way side in favor of the drug.


What to do if you suspect alcohol or drug use becoming a problem in a loved one or friend:

I can assure you that you will have similarly obvious signs and symptoms of drug use with individuals addicted to narcotics or marijuana. As you can see, when you get educated there are actually a whole host of signs that can identify alcohol or drug addiction in a family member, loved one or friend. The key is that if you notice a pattern of a lot of little (or big) changes in someone that you care about, you should NOT ignore it. Rather, you should openly express your concerns and suspicions. However, this confrontation is sometimes uncomfortable for both parties. If the loved one is addicted, they will most likely respond with anger and denial, trying to move the blame to just about anything or anyone else in their life other than themselves.

Despite the addict's response to confrontation, your best defense against "hidden addictions" is to not put your head in the sand. Instead, review the lists above as well as the website www.enterhealth.com or my book Healing the Addicted Brain to look for more specific indicators. Once you suspect alcohol or drug use, make sure to confront the person in question when they are NOT INTOXICATED - I can't stress how important this single recommendation is! When someone is intoxicated with alcohol or drugs, their brain is pretty much "offline" - this is a brain disease, remember? Therefore during the intoxication/use phase the individual is just not able to process what you are saying and is at much higher risk to use poor judgment (i.e. inappropriate anger outbursts or resorting to violence more easily than normal). The optimal approach in this very uncomfortable conversation is to be honest and supportive of the person rather than being critical. Also, have some specific facts or lists of concerning signs or symptoms that you have observed or are worried about.

Finally, because denial can be so strong in most alcoholic/addicts, you may not get at the truth on the first one or two conversations. If you continue to see the signs, call for reinforcements! Find other people to help you confront the person that you care about (pastors, friends or even health professionals - doctors, therapists, interventionists). Remember, this is a life-threatening illness - don't stop trying to get your loved one help just because the process is hard or uncomfortable. You can make a difference!

Thanks for reading, and as always, please feel free to ask me any questions.

-Hal

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