Treatment

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One of the best recovery tools that does not get its rightful due in the debate among the popular treatment options is exercise. Hundreds of studies have found a positive link between exercise and reducing depression, the most recent coming from Sweden which found that well-trained skeletal muscles may provide the brain with an edge over stress, and ultimately engender protection against stress-related depression.

There have been a few studies done on exercise and the treatment of addiction. A 2009 study in Pathophysiology Journal showed treadmill exercise reduced morphine use in male rats. And in 2011, a study in the journal Current Neuropharmacology demonstrated animals’ preference for saline over amphetamines when they exercised.

Exercise releases endorphins and boosts serotonin levels. Endorphins are the body’s natural pain medication. They interact with human opiate receptors, which reduces your perception of pain. Serotonin are hormones responsible for mood balance and are the targets for widely used anti-depressant medication like Celexa, Lexapro and Zoloft. Less pain, better mood and all natural? That should be a no-brainer for any alcoholic/addict right?

Since I entered recovery about 3 years ago, I’ve put on a bunch of weight and I’ve not been feeling very good about my physical appearance which has affected my mood and self-esteem. While I go to the gym a few times a week and have taken up cycling, I haven’t found a consistent exercise regimen to take off the extra weight and get back to my “fighting” shape.

That has changed since I joined Title Boxing Club and participated in their intense boxing training workouts 3-4 times per week. The 60 to 75 minute classes are INTENSE even for the most in-shape person, but anyone can do them and you are free to modify the workout to lessen the intensity.

It’s a group class lead by a real amateur boxer/trainer centered around the scores of heavy bags hanging from the workout ring. Your hands are protected with real boxing wraps and you are provided with big, thick heavy bag boxing gloves. (New member deals often include a free set of wraps and nicer gloves). The first 15 minutes is a “warm-up” with jumping jacks, simulated jump roping, lunges, mountain climbers and shadow boxing. I am usually in full sweat 5 minutes into the warm up. The next phase is the boxing, with 8-12 “rounds” of punching combinations on the heavy bag with one minute active rest periods. Jabs, cross, hooks, uppercuts, bodyblows, 3-4-5-6-7 punch combinations, ending with a 30 second punch out as fast and hard as you can. The workout ends with 15 minutes of real boxing abdominal and core work, with punching sit-ups, leg lifts and planks followed by stretching.

Talk about stress relief. I am literally punching aways all my stresses and resentments in one session! The group format and trainer also motivates me to workout much harder than a normal gym workout. My competitive juices start coming out! There is also a group camaraderie with the sessions (sound familiar to AA folks?). I can feel the endorphins and that workout “high” for hours after a boxing training session.

After several months boxing, I’ve lost about 15 lbs, and can definitely notice a change in my body type as well as mood, energy and sleeping. My alcohol cravings have also gone down. When I have had a particularly tough day or when I feel depressed or anxious, hitting the bag for an hour always puts me in a much better frame of mind. In fact, when I don’t box or work out, I feel crappy.

As you can see, I highly recommend boxing as part of my recovery program. Of course, you don’t have to do boxing, just get out there and exercise and it will help!

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Hijacking The Brain, How Drug and Alcohol Addiction Hijacks our Brains – The Science Behind Twelve-Step Recovery

During my time-off, I read this amazing book called Hijacking The Brain, by Louis Teresi, M.D., a Harvard neuro-scientist and also a recovering alcoholic. This book, for me, was like a gift from heaven. As you could tell from previous posts, my analytical attorney brain has always asked the question, “How does the 12-step program of Alcoholics Anonymous really work”? Forget the blind faith and the answers from old-timers (“It just does..”). I needed evidence, data, and scientific proof. Well, this book answers the question and explains a lot more about the chemistry of addiction. Here are a few passages from the book:

Just as viruses hijack a cell’s RNA and DNA, drugs of abuse hijack the brain’s core reward pathway to promote continued use. Just as the cell’s survival is dependent on its core DNA and RNA, so is the survival of the organism dependent on an intact brain reward pathway. By hijacking the brain’s reward pathways, drugs of abuse—through changes in emotions, cognitive function, and behaviors—all too frequently lead to severely negative consequences for the host/user, including death.

This “hijacking of the brain” is the central theory of the book. It seems common sense to any alcoholic or drug addict, but to “normal” people, they don’t really understand how alcohol and drugs literally change the brain. It’s like brain damage. Well, not like it, it is brain damage.

Addiction is due to a dysfunctional, substance-dependent reward system, and is characterized by a stress state and cognitive impairment. Once an addict takes a drink or drug, the brain’s limbic reward centers are activated strongly while, concurrently, the stress-response is activated and decision-making centers in the frontal lobe shut down. The body is reacting to a foreign substance that disrupts the nervous system. There is elevation of the stress hormone, cortisol, and a generalized increase in the activity of the excitatory nervous system, particularly in withdrawal states and in reaction to life stress. There is associated cognitive decline characterized by poor decision-making and judgment.

Dr. Teresi talks quite a bit about addiction’s effect on the brain’s limbic reward system — our primitive reward center. As he concludes, “mood altering drugs hijack the brain’s reward centers, leading to compulsive thoughts and behaviors to acquire the mood-altering substance. Consequently, thoughts and behaviors needed to survive are displaced; all the addict or alcoholic wants to do is more of his or her drug of choice.” Any alcoholic can attest to the overwhelming and powerful forces of craving and obsession to drink, and how hard it is to “fight” those forces. Moreover, addition compromises the alcoholic’s cognitive/front lobe functionality — literally making you stupid and incapable of thinking clearly and rationally. Hence, the reason why very smart alcoholics (like myself) engage in incredibly stupid and self-destructive behaviors.

With exposure to drugs or alcohol the stress hormone, cortisol, is elevated throughout our bodies, which potentiates and perpetuates the addiction and further cause’s cognitive impairment and damages other organ systems.

Dr. Teresi also discusses the stress hormone, cortisol. I know stress is one, if not the biggest, reason why I drank. The irony is that drinking at first calms you, but then turns on you, flooding the body with nasty stress hormones, and perpetuating a vicious cycle of wanting to drink to relieve the symptoms of stress. I didn’t really understand this process before reading this book.

Chronic Low Grade Agitated Depression: addicted individual experiences a chronic state of low-grade agitated depression due to abnormally low release of brain reward chemicals. This state is dysphoric and generates an urge to find something—anything— that will relieve this state.

The Big Book famously describes an alcoholic’s state of being “irritable, restless and discontent.” This state of feeling “yucky” is actually chronic low grade agitated depression, and is completely normal and common in early recovery and beyond. Whew, and I thought I was going crazy feeling like crap all the time…

The positive, empathetic socializing experience of the Twelve-Step group makes the addict “feel good,” which is why it is essential for recovery. Several empirical studies support this hypothesis and indicate that social reward is processed in the same brain reward centers in the limbic system as non-social reward and drug addiction. Working the Twelve Steps involves surrendering to a Higher Power and “letting go” of fear, resentment, guilt, self-pity and self-loathing. These emotions are known to be associated with stress physiological states, as exemplified in high autonomic nervous system tone: high blood pressure, elevated respiratory rates, and elevated cortisol (stress hormone) levels. Twelve-Step programs emphasize living along the lines of spiritual principles of honesty, humility, tolerance, patience, acceptance and empathy.

Numerous lines of research have shown that the processes of empathetic social interactions and spiritual practices stimulate the brain’s limbic reward centers, normalize hormonal imbalances and, therefore, we can hypothesize that these “natural” rewards replace those of the addictive substance. With empathetic socialization and spiritual practices, stress is reduced, lowering the blood cortisol level, increasing parasympathetic tone and stimulating oxytocin release.

Here are the goods. Participating in a 12-Step program makes the alcoholic/addict feel good and feel better. It’s a simple as that. Also, the fellowship of AA and 12 Step programs reduces stress and increases the release of the “good” hormones. As any AA member knows, we often feel much better leaving a meeting than when coming in!

Brain imaging studies also show that spiritual experiences achieved through intense meditation and prayer decrease activity in the area of the brain that orients our bodies in space, encouraging a blurring of the normal sense of self. This brain activity can stimulate feelings of mystical unity, “oneness,” peace, and even the sensed presence of God or other invisible entities.

Dr. Teresi advocates for lots of meditation and prayer, citing numerous studies that it makes the alcoholic feel better and heal those damaged neuro-pathways. This is an area which I definitely need to work on. In the morning, I do some reading out of the Hazelden 24 hour book and have begun to pray now and then, but I would love to find a weekly meditation group or class.

Well, that’s all the time I have today. I highly recommend picking up the book!

One day at a time, Dick

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smart recoveryAs many of you know, I’ve been looking into the SMART Recovery program. I wrote about it previously in this post, Is Smart Recovery A Smart Choice For for An Alcoholics Anonymous Member? I can say that for this alcoholic, it was a smart choice, and I got a lot out of it. I’m just going to add this 1x/week meeting to my recovery program, and continue to go to my regular 3-4 AA meetings a week.

What appeals to me about the SMART program is that it’s based on the current thinking and research in addiction and cognitive/behavior strategies  – something that Alcoholics Anonymous has failed to fully embrace. Overall, the meeting was very similar to my counselor-led group sessions at Hazelden which I got a lot out of. My guess is it is also similar to most out-patient group sessions led by addiction counselors.

The meeting was held at an air-conditioned conference room at a local hospital. Definitely more comfortable than a stuffy, hot church basement. The meeting was led by a trained facilitator. He was an alcoholic, and I assume that he went through some type of SMART training to be certified as the group facilitator. Very nice guy and managed the meeting very well.

The first part of the meeting was a “check-in.” Everyone at the meeting had the opportunity to introduce themselves and speak for about 2 minutes or so about why you were at the meeting or how your week was (or anything bothering you for that matter). Unlike AA, there is no requirement that you have to identify yourself as an alcoholic, addict or any type of label. There seems to be quite a few folks very new to recovery, so I’m sure they didn’t necessarily feel comfortable labeling themselves an alcoholic or drug addict right from the start. I’m so used to AA that I introduced myself in the usual “Hi I’m Dick and I’m an alcoholic.” SMART meetings are open to any type of addict so there were folks there struggling with drugs, alcoholic, over-eating and some just dealing with severe depression or anxiety. It was an interesting mix of people struggling with addiction and related issues.

The second part of the meeting was more unstructured. Unlike AA, at SMART meetings, cross-talk and a healthy back-and-forth is actually encouraged. The facilitator actually started asking me questions about my recent struggles. Whoa, I was a little taken off-guard, but it was a good thing. Some other folks chimed in with comments and questions – which were good and got me thinking about some things I wasn’t doing in my own recovery. One or two questions/comments were a bit off-target, but that’s the nature of the beast. Actually, there was this very annoying know-it-all guy who kept interrupting me and others with inane comments. That doesn’t happen in AA, obviously. The discussion then took on an organic flavor with participants discussing such topics as dealing with drinking events, relapse, trying to stop cigarette smoking, and the benefits of psycho-therapy and anti-depressant medications.

I would say that SMART’S allowing of cross-talk was the most negative part of the meeting. If the facilitator isn’t strong, the meeting could get hijacked by an individual and that would be unfortunate.

The next part of the meeting was an exercise led by the facilitator. Using a white board, we did a Cost-Benefit Analysis of drinking/using versus not. We all threw out reasons why drinking was a “good thing” and benefited us – dulls pain, makes us feel good, increases sociability, it’s fun, we like it, etc. Then we brainstormed all the costs and downsides of drinking – unhealthy, financial ruin, harms loved ones, affects career, legal consequences, it’s a depressant, shame/guilt, makes us act irresponsibly, etc. Seeing all the reasons on the white board, it was, of course, a no-brainer that drinking/using provided far more in “cost” than “benefit.” This may be a “duh” moment for any “normie” but for us alcoholics, it was helpful to see it in writing in front of us.

The last part of the meeting was similar to the first, kind of like a recap. We went around and shared what we got out of the meeting and what we were looking forward to or what we intended to work on for the following week.

All in all, it was a positive experience, but I can already tell that for me, just using SMART alone, won’t cut it. I still need the AA fellowship and diversity of meetings, and I still need private therapy and the online recovery community as part of my own recovery program.

I received a handout at the end of the meeting which summarized the principles of the SMART Recovery program, which I’ll share here. It’s somewhat similar to the AA Twelve Steps but without the Higher Power/God piece. Some appealing ideas….

  1. Completely accept that you are fallible. Your fallibility including thinking in a manner that greatly hinders you in your individual pursuits and in relating to people with home you live, work and associate.
  2. Intensely focus on eliminating your emotional upsets quickly (as soon as they occur) and regularly (several times a week). Follow this practice to give yourself more freedom from self-defeat and toward happiness.
  3. Forgive yourself your mistakes. You will make many of them. Practice effective self-help techniques and you will eventually improve your behaviors and your abilities to change. Tolerate others’ shortcomings and forgive their mistakes. Keep your friendships even with their problems, because you won’t find any that do not have them.
  4. Accept that you are a creature who thrives on happiness, delight, joy, and love, and work to develop your ability to find and achieve these in as many ways as you can.
  5. Accept yourself with your mistakes and shortcomings.
  6. Work and practice, and you will eventually improve your abilities to change.
  7. If you have attended SMART Recovery meetings and found them helpful, continue to attend and help yourself and others.
  8. Continue your Rational-Emotive education through reading REBT books and other materials.
  9. Work on upsets quickly (as soon as they occur) using DIBs (Disputing Irrational Beliefs) and the other REBT techniques you have learned.
  10. Work and practice – practice and work!
  11. Absorb yourself in a long-term interest that brings you happiness!

I’m interested if anyone reading this blog has experience, good, bad or indifferent, with the SMART program. Comment below!

One day at a time, Dick

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“The Situation” Sobers Up

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If you don’t know who Mike “The Situation” Sorrentino is from MTV’s Jersey Shore reality show, you’ve lived under a rock for the last few years. The show is a maelstrom of booze, partying and debauchery depicting the lives of a bunch of 20 year olds living on the Jersey Shore.

One of the “stars” of the show, Mike “the Situation” Sorrentino, just came back from treatment for prescription pain medication addiction. Surprisingly, The Situation seems to have grasped some of the basic principles of recovery. I was particularly impressed with Mike’s articulation of the “one day at a time” philosophy in the face of a question about him being afraid of relapsing, and his being humble in the face of what is surely a humiliating set of circumstances. I also appreciate how Mike describes the first days in treatment with the emotions hitting you “like a ton of bricks.”

For Mike, like all fellow recovering patients emerging from the safe cocoon of treatment, the real work of sobriety has only begun. As a sober person, Mike’s career choice and lifestyle in the entertainment industry will surely give him a huge challenge. There are reports he may have a live-in sober companion during the next season of Jersey Shore.

Unfortunately for Mike, the reality show industry feeds off of the antics of alcohol and drug fueled “cast members” like Snooki and Pauly D. While disappointing, the average reality show viewer will be quickly bored of Mike heading to a 12 step meeting instead of clubbing. Maybe Mike can get on the new reality rehab circuit with Dr. Drew and company!

Seriously, I hope The Situation is able to stay sober, and wish him the best in his recovery.

One day at a time…

~Dick

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alcohol anxiety panic attack

I Used Alcohol To Combat Anxiety, But Alcohol Itself Causes Anxiety

In 2006, I suffered my first full blown panic attack. I remember it like it was yesterday. I was reading a bedtime story to my son and felt this weird flip-flopping in my chest. My heart was doing somersaults. Having never experienced any type of heart irregularity, naturally I thought I was having a heart attack and would be dropping dead within minutes!

Instead, I was experiencing a panic attack. The flight or flight response kicked in and my body dumped a pint of adrenaline into my bloodstream. Shortness of breath, chest pounding, head spinning, nausea, thoughts racing and buzzing, dizziness, gastro-distress, you name it, I had it.

I wound up being rushed to the ER in ambulance. After ruling out a cardiac event, the EMT said “Dude, it’s probably a panic attack. You’re going to be fine.” Panic attack, I said? Huh?

Well, turned out there was something wrong with my heart. A cardiologist diagnosed me with premature ventricular contractions (PVCs) which thankfully are benign, fairly common, and don’t cause heart attacks. Basically, the heart beat is a little out of rhythm at times, but correctable with medication and weight loss.

But the scary feeling of my heart doing weird things definitely caused the panic attack. It also didn’t help that at that time in my life, I was dealing with a layoff, moving the family out of our house and into a smaller house, a new baby, losing my wife’s income, hating my job, the inevitable strain on our marriage caused by all the above. And of course, I just internalized everything, telling people I was “fine” and I’m a “fighter.” It was just a matter of time before I cracked under the pressure.

The panic attack did a number on me. For the next several months I had more bouts of anxiety and panic. I was having difficulty concentrating at work and home. I could hardly drive down the highway without starting to feel anxiety. I was continuing to have panic episodes. I sunk into a depression. I didn’t know if I could pull out of it. The shrink put me on Zoloft and Xanax which hardly worked. I did some cognitive-behavioral therapy with limited results.

Then entered my good friend alcohol. Up until then, I hadn’t made the medicinal connection between alcohol and anxiety. But knocking back a few cocktails after a panic episode, I felt instantly better. A lot better. I developed this mind-set that as long as I had alcohol around, I could self-medicate the panic attacks. And that’s what I did for a while. Long enough to start the progression into alcoholism.

Little did I know that the alcohol negated my medication and was a depressant and anxiety-causing agent itself. Ironically, the alcohol ultimately caused more anxiety and more depression, which I had to feed with more alcohol. A veritable Catch-22.

Research studies have shown that alcohol consumption causes anxiety by affecting serotonin levels in the brain, dropping blood sugar, elevating the heart rate, and causing dehydration and hyperactivity. Researchers and clinicians have long observed that the rate of anxiety disorders among those suffering with alcohol dependence is two to four times greater than that found in the general population.

My panic attacks eventually resolved, especially after a full cardiac workup showed I was in no danger of dropping dead, and I learned some helpful relaxation and deep breathing exercises. The panic attacks went almost completely away when I stopped drinking a year ago. But they came back every time I relapsed. Coincidence? I think not.

Suffering from anxiety and panic attacks are not fun. Drinking is probably one of the worst things you can do. I didn’t know that until I became educated on the disease of alcoholism.

One day at a time…

~Dick

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My Hazelden Experience: The Power of the Peer Group and Fellowship

January 14, 2012

“One foot in, for those left out…right foot here for us. God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. So be it!” My peers and I at the Hazelden Treatment Center said this variation of the […]

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Commitment To A Local Detox Unit

January 14, 2012

The other day, I attended my AA home chapter’s weekly “commitment,” or service project, to a local hospital detox unit. It reminded me of my time at Hazelden where the first 24 hours are spent in a monitored detox area where the nurses would check on you every 6 hours. My sponsor said it would […]

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