Frequently Asked Questions About Drugs and Addiction

Is it normal to use drugs?
We see the drive to alter consciousness across time and cultures. Every culture has norms and rituals for preparing and using psychoactive substances. As a Human Universal, it’s hard to say that altering consciousness is not normal behavior.

Is alcohol a drug?
Yes.

What is addiction?
The mental health field in the United States is moving away from the term “addiction” and towards discussing “substance use disorders.” Substance Use Disorders are when someone experiences some negative consequences like loss of control, changes in social behavior, and health consequences related to a substance. About 1 in 9 people who use substances meet the criteria for a substance use disorder.
Many people can use substances in an acceptable way and cut back when their use negatively affects them. Addiction is when someone finds they continue to use despite negative consequences and despite the desire to stop.
Please also check the American Society of Addiction Medicine’s page on the definition of addiction as it is an excellent resource.

Why can't people just choose to stop?
Addiction is a disease of the brain that affects its ability to interpret and recall pleasure and pain. The misinterpretation of pleasure and pain affects the part of the brain that makes choices. Over time, the faulty recollection of pleasure and pain leads to lack of motivation to change and a belief structure that supports the addictive behavior.

Why is addiction treatment important?
Addiction treatment isn't there for people who are comfortable with their substance use. Addiction treatment is there for people who find they struggle to cut back on their own and need help. Studies have found that spending money on evidence based addiction treatment is far more effective at reducing costs to society than trying to stop the inflow of drugs or enforcing punitive drug laws.

Can anyone become addicted?
There are many genetic and environmental factors that contribute to addiction. It is possible that with repeated exposure to addictive substances or behaviors that anyone can become an addict.  So while having family members who deal with addiction is a good sign you may experience addiction, not having family members who deal with addiction is not a guarantee that you will not experience addiction.

Isn't calling addiction a disease just an excuse?
We know addiction is a disease because it comes from predictable stressors, causes predictable symptoms, and benefits in predictable ways from treatment.  Calling addiction a disease explains the behaviors we see as symptoms of a substance use disorder, but doesn't excuse them.
No one chose whether they are susceptible to addiction.  But almost everyone dealing with substance use problems have moments of clarity where they notice their behavior around their use is a problem.  Recognizing that addictive behavior has become a problem entails being responsible for getting appropriate help.

Are addicts just bad people?
No. The fields of medicine and health have only recently begun to view addiction as a problem within their scope - we are still in the early stages of recovering from a century of viewing addiction as a criminal justice problem.  Because it's a long-stigmatized problem, a large majority with addiction problems do not seek out treatment.
People dealing with addiction often behave badly when they are actively in addiction.  The drug has become their brain's survival priority.  With their brain sending overwhelming emotional signals to "get the drug, it’s the most important thing!" many people behave in reprehensible ways and do things against their moral codes. 
The more we understand addiction as a disease, the more we will understand the behavior of people suffering from addiction as symptoms.  The behavior of addicts typically goes away with predictable treatments, which lends credence to the notion that they are patients dealing with symptoms, not bad people suffering from moral failings.  If we can discuss addiction in a way that brings less shame to those suffering from it, we allow more people to get help.

How do I know if I have a problem?
If you’re bothered by how preoccupied you are with drinking or getting high or struggle with reducing negative behaviors related to substances that lead you to be defensive to others and latch onto stories to justify your use to yourself then it may be wise to discuss your experience with someone who has experience diagnosing and treating substance use disorders.

What if I’m interested in changing my relationship with some substances but not interested in abstinence?
We can have different relationships with different substances. Abstinence is a the right option for some people at some points but it certainly isn’t the only option. Others may want to be completely sober from one substance but not from others. Some find that they are able to achieve their goals by moderating. Treatment is helpful for people in various situations with various goals.

Is recovery from addiction possible?
Recovery from addiction is about changing the beliefs, attitudes and behaviors that led to and maintained the problem. Recovery is a long-term process. There are no quick cures nor is there just one way to get into recovery but those who have the desire and willingness to put in the work do recover.

Evidence Based Wellness Choices to Make Life Better

1.    To Best Understand The Role of Diet, Exercise and Sleep Begin with a Detailed Journal. Using an app like MyFitnessPal is a quick way to start a food journal.  Documenting is an excellent way to learn calorie and nutrition content and gain insight regarding what your choices really entail.  Keeping track is the best way to learn what gets in the way and what actually works for you.

 2.    Eat Real Food. Comparisons of diets have discovered there is no one solution to “the best diet.”  However, they were able to conclude that, “A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.”[1]  Processed food is food that is changed in any way before it’s made available to eat including freezing, canning, salting or drying. 

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3.    Control Appetite by Eating Nutrient Rich Sources of Protein. Eating carbohydrates can make you feel hunger sooner than eating more nutritious food.  Eating foods that make you feel full is an important aspect of maintaining a healthy diet.  A major study determined, “protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption.”[2]

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4.    Engage in Vigorous Physical Activity. Find or pick a physical activity that captures your interest.  It can be as simple as a daily walk or a complicated as competitive fencing.  Keep yourself involved by making it a habit, making it part of your routine or commit by signing up for groups or classes.  Schedule when you’re going to do it throughout the week and commit to going beforehand rather than leaving the decision up to the moment. 
 

 5.    Manage Sleep with Consistent Routine and Schedule. Limit daytime naps to 30 minutes. Avoid caffeine for at least 6 hours before bedtime.  Engaging in 10 minutes of daily exercise has been shown to improve quality of nighttime sleep.  Get out in the sun during the day to encourage a healthy sleep-wake cycle.  Develop a bedtime routine such as taking a bath, stretching, or reading.  Avoid screens and emotionally stimulating material in the evening.  Taking too long to fall asleep at night is a sign you should evaluate your habits as you approach bedtime.[3]

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[1] Katz, D. L., & Meller, S. (2014). Can we say what diet is best for health?. Annual review of public health35, 83-103.

[2] Paddon-Jones, D., Westman, E., Mattes, R. D., Wolfe, R. R., Astrup, A., & Westerterp-Plantenga, M. (2008). Protein, weight management, and satiety. The American journal of clinical nutrition87(5), 1558S-1561S.

[3] National Sleep Foundation. What is Sleep Hygiene?. Retrieved from https://sleepfoundation.org/sleep-topics/sleep-hygiene

What We Know About Preventing Adolescent Substance Abuse

There's a wealth of information available online about substance abuse.  The results of massive, government funded studies are available at places like SAMHSA.gov.  The results of these studies are available for free, which makes my job a lot easier.  The tricky part is interpreting the results.  When we collect data for studies, we try to do so impartially as possible, removing all human bias.  However, when we look at that hard data and try to make sense of it, human bias comes back into play and it's easy to lose track of what's really going on.  So let's look at the results of the National Survey on Drug Use and Health (NSUDH) and try to make sense of some of it.

The results of the 2013 NSUDH mostly cover prevalence, ie. how many kids of each age group are using which drugs. But one section of the study is devoted to "Youth Related Prevention Measures."  The study had questions which measured the correlation between kids answers to questions like, "do your parents help you with your homework" and "have you used marijuana in the last 30 days."  And they found some interesting correlations that let us know specific things we can do to help adolescents avoid falling into substance abuse!

Now, there are a couple caveats here before we dive into what the findings.  First caveat: correlation doesn't imply causation. If a kid is less likely to report marijuana use when he reports his parents frequently help him with his homework it doesn't mean those two things are directly related. It's possible they are indirectly related through a third factors like a feeling of connectedness that comes from having good family relationships.  Second caveat: we only know the connections that this particular study asked specific questions about.  If the study did not ask (or did not analyze) questions about exercise or number of close friends then we cannot use its results to examine the relationship between those factors and substance abuse.  Science is hard: sometimes we miss out on the most important connections because they're difficult ones to measure.

So what prevents youths from abusing substances? Here's the short list from the 2013 NSUDH:

  • Perceived Risk of Substance Use
  • Perceived Availability
  • Perceived Parental Disapproval of Substance Use
  • Attitudes toward Peer Substance Use 
  • Fighting and Delinquent Behavior 
  • Religious Involvement and Beliefs
  • Exposure to Substance Use Prevention Messages and Programs 
  • Parental Involvement

Seems to make sense. If a kid believes drugs are bad, mom and dad would be mad if you did them, and drugs are hard to get, then that kid wouldn't do them.  Kids with high perceived risk, perceived parental disapproval, religious involvement, parental involvement, and exposure to substance use prevention messages were less likely to report substance use in the past month.  Kids with negative perception of drug users and lower engagement in fighting and delinquent behavior were less likely to report substance use in the past month as well. 

Let me focus on a few areas of the findings: Perceived Risk of Substance Abuse, Perceived Parental Disapproval of Substance Use, and Parental Involvement.  I think these are the most important aspects of youth prevention for parents because they highlight specific things that parents can work on.

It can be hard for parents to communicate specific and accurate information on the risks of substance abuse to their teens because there can sometimes be conflicting information. And some of the best information is relatively new. Dr Frances E. Jensen released a book called The Teenage Brain last month. You can listen to hear speaking about the findings in her book on NPR here. In The Teenage Brain, Dr Jensen discusses recent studies in neuroscience that demonstrate the long-term risks of drug use on the developing teenage brain.  She strongly encourages parents to use her book to gather accurate information about the risks of adolescent drug use and then discuss them with their teenagers.  She also speaks at length about the planning part of the brain that anticipates risk and consequences, the prefrontal cortex, and how it isn't fully connected in the teenage brain.  She encourages parents to help teenagers plan for and weigh risks because their brains aren't yet fully able to do so.

How should parents talk to their teens and tell them they would disapprove if they found out they were using drugs? Calmly and directly.  If a parent is emotionally overwhelmed by the idea of drug use it's likely the message might get lost in all the emotional charge.  If mom screams, "Don't ever let me find out you're using drugs!" then she'll get what she asks for. If her kids use, they will hide it.  It's important to leave the communication lines open with a calm and direct statement like, "I know there are going to be kids drinking, smoking pot, and using other drugs at your high school and I know there's a chance you might end up trying these things as well. I really hope you don't.  At this age your mental development can really be thrown off by even a little drug use, so even if you think you might try it, I hope you choose to put it off for now." Being able to make that statement without an emotional charge leaves your kids with the nonverbal message, "If I am ever in trouble with drugs, I know my parents won't just freak out on me. I know they'll be there to help me."

Being involved in your kids life is a huge factor in preventing substance abuse.  The NSUDH study looked at specific things like whether the kids reported that their parents helped them with their homework, whether they had a curfew on school nights, and whether their parents let them know when they did a good job.  In kids who reported parental supporting and monitoring, tobacco, alcohol and drug use rates were cut in half.  And that relationship gets at an incredibly important and very new idea in the realm of addiction treatment.  Connectedness is a key factor in preventing substance abuse and addiction.  Old studies that seemed to that cocaine was universally addictive in lab rats are being challenged by new studies that show rats living in communities will only become addicted in the absence of healthy social interaction.  You can read an excellent description of recent studies on this in this recent article in The Huffington Post. But the takeaway message is to communicate, connect, participate and be involved with your kids if you want them to lead lives free from substance abuse issues.