By Jane Leder
After both her parents died of cancer just two years apart, Jean Olsen went into an emotional tailspin. To ease her troubled sleep, the 40-something nurse from Tennessee started taking Vicodin, a narcotic analgesic she found in her mother’s medicine cabinet. When the prescription ran out, Olsen began stealing Vicodin from the hospital where she worked.
She also started helping herself to the prescription narcotic Scadol after an old migraine problem flared up. The drug not only relieved Olsen’s pain but made her feel euphoric, and it enhanced her sexual pleasure. Within a year, she was addicted to both drugs. After being fired from her job for stealing drugs, Olsen checked herself into an inpatient detoxification program, though she still wouldn’t admit to having an addiction. She also sought treatment at a group apartment for addicts and an outpatient program, where she admitted to being an addict for the first time. Yet neither of those approaches worked. In the midst of everything, she became clinically depressed. Only after being treated by a doctor who specializes in addiction and attending daily Narcotics Anonymous meetings was Olsen, now 54, finally able to conquer her addiction.
For Carol O’Hare, 44, the road from a gambling addiction to recovery took a different route. Her problem began more than a decade ago, when she was a newly divorced mother of three with no job skills. To relieve stress, the Las Vegas resident started playing video poker and was soon hitting the casinos every night. O’Hare’s gambling addiction bled her dry. She lost her children’s savings bonds, a lot of borrowed money and her peace of mind. Physically ill and emotionally depressed, she shared her problem with a friend, who recommended Gamblers Anonymous. The meetings made O’Hare realize there is no magical cure for her addiction. “For me, it was crucial to learn what I was going through wasn’t a moral issue but a mental health problem,” she says. O’Hare has not only recovered but now helps others fight addiction as the executive vice president of the National Council on Problem Gambling.
Mary Sonntag, a 41-year-old New York City resident, also overcame a behavioral addiction, one that developed during her senior year in college. Her battle with eating disorders started when the 5-foot-3-inch, 120-pound student forced herself to throw up, or purge, because she felt too full after a meal. The incident mushroomed into an obsessive pattern of dieting and exercising. A year later, Sonntag weighed 78 pounds and was eating only eight corn nuts a day.
Sonntag was diagnosed as anorexic and bulimic. She was hospitalized three times in the next decade but continued her self-destructive behavior. Therapists rewarded Sonntag when she gained weight and “punished” her with hospital time when she didn’t. That treatment didn’t work; neither did counseling sessions or attending Overeaters Anonymous meetings. A desperate Sonntag eventually found a lasting cure at a private addiction facility that integrated conventional approaches with alternative treatments like yoga and acupuncture. Today, she’s a psychotherapist specializing in eating addictions.
The Nature of the Beast
Sonntag. O’Hare and Olsen are hard-working, well-intentioned women whose addictions ultimately got the best of them. Like millions of Americans, they discovered that the substance or behavior that initially provided solace eventually had become a source of misery. They paid a heavy price for their addictions, chiefly an emotional and physical dependence, as well as the financial strain of feeding it. Beyond the havoc it wrecks on people’s lives, addiction also carries with it a persistent social stigma –in spite of the new scientific understanding of the brain’s role in addictive problems. To many, chemical dependence or behavioral disorders are still perceived as moral or even criminal deviances. “Prejudice against addicts as weak-willed people who can kick their addictions if only they would try remains embedded in the public consciousness,” says Sheldon Miller, M.D., a psychiatry professor at Northwestern University in Chicago.
Physicians also tend to treat addiction as an acute condition rather than adopting the more cutting-edge view of it as a chronic problem like arthritis or hypertension (i.e., it can be controlled but not cured). “It’s really a day-to-day struggle for many people, and some of them require long term care,” says Diana DiNitto, Ph.D., a professor of social work at the University of Texas-Austin. In fact, she says, the emphasis of addiction treatment has shifted from intensive, 30-day detoxification programs to long-term outpatient care focused on preventing relapses.
Despite the persistent stereotypes, researchers have made ground-breaking progress in their understanding of its causes and consequences. Substance addiction is now considered a brain disease that fundamentally alters the way the organ processes and communicates information. And although it has yet to be clinically proven, researchers suspect the same principle is at work with behavioral addictions like eating disorders and gambling. Yet addiction doesn’t always manifest as ardent drug addiction or alcoholism. It can also be about eating disorders based on a poor self-image or an obsessive concern with weight control. This knowledge can help many of us, even those who don’t think of ourselves as addicts but do acknowledge our lack of control over food.
As a result, treatment has evolved far beyond crisis intervention. While most addiction centers still base their approach on the 12-Step Program –developed in the 1940s by the founders of Alcoholics Anonymous –a new breed is now integrating complementary therapies to bolster a patient’s body and spirit against the ravages of addiction. Beyond the fundamentals (behavior modification, cognitive therapy), most programs emphasize a healthy diet and regular exercise along with meditation, yoga, acupuncture and biofeedback. “We’re in a very pioneering time right now,” says Barry Sultanoff, M.D., a psychiatrist who practices in Kensington, Md. “Being in recovery doesn’t necessarily mean people are actually living healthy lives. What we’re talking about now is an evolution from the strict 12-step model to incorporating the best of that which what we know about mind/body medicine.”
There have never been more tools available to conquer unhealthy dependencies as there are today. It will take time and may involve setbacks, but there’s no doubt that improving physical health and nurturing the soul will not only weaken an addiction’s stranglehold on one’s life, but also may make life richer than ever.
Private Problem, Public Concern
It’s no longer shocking to learn of an athlete’s private struggle with drug addiction or an actor’s ongoing battle with an eating disorder. But too often, the broadcast version of the story focuses more on the professional or criminal penalties people pay for their addictions than the tragic nature of the disorder. It’s important to realize, however, that addiction is actually very commonplace. Experts say 10 to 15 percent of all Americans will develop a drug or alcohol dependency during their lifetime. This is why DeNitto believes it’s critical that addictions be regarded as a public health problem.
While it’s difficult to get precise statistics due to client/therapist confidentiality and the fact that many addicts face obstacles getting treatment (lack of insurance, etc.), it’s safe to say that nicotine is the most prevalent substance abuse problem in America –more than 48 million Americans smoke cigarettes. An estimated 14 million have difficulty controlling alcohol consumption. This number includes both abuse and alcoholism, which addiction specialists consider separately. At least 15 million people have admitted to using illegal drugs. Anywhere from 5 million to 10 million women and approximately 1 million men suffer from eating disorders, but experts believe sex and gambling addictions may be growing at the fastest rate. Some 5 million Americans are considered sex addicts. Mental health practitioners say people are now more willing to admit to compulsive sexual behavior. And gambling problems –afflicting about 7.5 million people –are increasing as more casinos open for business. In fact, since 1975 the gambling industry has grown tenfold. Prior to 1990, legal casinos existed only in Nevada and Atlantic City. Today, at least 47 states permit some form of gambling.
The Science of Addiction
Researchers say they now have traced the root of addiction to one of the most complex and misunderstood human organs: the brain. Exactly how casual substance use spirals into addiction is still not completely understood. But many believe the problem occurs in the nervous system of the brain that releases chemicals called neurotransmitters (like dopamine, serotonin or endorphines). These neurotransmitters send messages of sensation from one nerve cell to another. Recent research suggests that individual variations in the levels of dopamine may make some people more vulnerable to addiction than others. In fact, many researchers believe people who develop addictions have a genetic malfunction in this neurotransmitter system –either producing too little dopamine or breaking it down too quickly, says Carl Erickson, Ph.D., a pharmacy professor and director of the University of Texas Addiction Science Research and Education Center.
“When you take a drug that matches the effect of one or more neurotransmitter, you can become addicted because the drug is making up for a system that is not working properly,” Erickson explains. Here’s how the process works: Certain addictive substances increase dopamine levels, creating intense drug-induced feelings of pleasure. Once the brain and body become conditioned to the highest dopamine levels, creating intense drug-induced feelings of pleasure. Once the brain and body become conditioned to higher dopamine levels, they need increasingly more of the substance to attain the same euphoric effect. “Some people say they feel normal for the first time in their lives when they take a drug [like cocaine or drinking an alcoholic drink],” he says.
As the brain’s memory and learning processes grow accustomed to a substance and the sensory elements involved in the drug experience, these functions begin to change. “One of the things we now know about addiction is how people, places, and things become associated with drugs and getting high,” says Charles Schuster, M.D., a psychiatry professor at Wayne State University in Michigan. “Even when someone has stopped using drugs, just being around or thinking about these associations triggers cravings.” Schuster cites studies using magnetic resonance imaging (MRI), in which regions of the brain linked to both emotional processes and memory “light up” when a recovering addict thinks about drug buddies or other associations. “Thats’s why it’s so difficult to treat addiction,” he says. “You’re asking addicts to give up a learned response that translates into a way of life –their friends, their social activities, sometimes even their family.”
While addiction may be a chronic brain disease that can be passed on through the genes, environmental factors are equally important. “There’s no doubt that life experiences –everything from stress to grief to social circumstances –can play a major role in addiction,” Miller says. A person with a genetic predisposition to, say, alcoholism is more likely to become addicted if she has a stressful life experience.
Therefore, kicking a drug habit, Erickson says, is partially a matter of altering brain chemistry. This chemistry can change naturally as an addict starts focusing on learning new tasks, such as mastering the stages of a 12-step program, he adds. But the fact that addiction is a disease doesn’t exempt addicts from taking charge of their recoveries, cautions Alan Leshner, Ph. D., director of the National Institute on Drug Abuse at the National Institutes of Health. Just as hypertension patients must watch their diets, recovering addicts must follow treatment program is the first step, but they’re not guaranteed to work. Formal programs succeed for 50 to 70 percent of those recovering from drug abuse, according to an October study in the Journal of the American Medical Association. To truly banish unhealthy dependencies, people must learn new lifestyle habits that overpower their addictions.
Bolstering that process with more emphasis on health –and even happiness –gives addicts greater incentive to quash destructive addictions for good, says Sultanoff, coauthor of Putting Out the Fire of Addiction (Keats Publishing, 2000). Addiction often leaves people malnourished, immune-deficient, depressed and exhausted. Yet they respond dramatically to treatment plans that include not only diet and exercise components but spiritual therapies like meditation. “These things tend to be their own rewards pretty quickly,” Sultanoff says. “It’s a matter of making people realize how they can live to their fullest potential and really have a life that’s worth celebrating.”
Reclaiming Your Life
Breaking free –whether it’s from substance dependence or an eating disorder –involves combining an unwavering discipline with soul-sustaining tools that reduce cravings and gradually replace addiction with healthier habits. The process is as much about evolving one’s approach to life as it is about “staying on track.” In scientific terms, addiction may be a chemical imbalance. But psychologically, dependence on substances or negative behaviors is almost always an attempt to cover up feelings of emptiness. “[Addicts] want to feel more full, happy and alive,” Sultanoff says. “Their addiction might make them feel good in the short term, but it doesn’t hold very long and soon becomes a substitute for finding genuine pleasure and connection with other people.”
The Hazelden Foundation, a chemical dependence facility with centers in Minnesota, Illinois, New York and Florida, equips patients with a number of methods to combat their problems on the mental, physical and spiritual levels. At Hazelden centers, a 28-day inpatient program for drug and alcohol addiction integrates the traditional 12-Step Program with complementary therapies like meditation and biofeedback. The goal is to improve an addict’s neglected health, then enhance his state of mind so he can visualize a better life –without addiction. “Few people want to be abstinent but miserable. Our goal is to be abstinent with a fulfilling life,” says Tim Sheehan, Ph.D., vice president of Hazelden’s Minnesota recovery service.
Addiction specialists at Hazelden say their holistic approach starts with the basics. All patients are fed nutritious meals with generous portions of fruits and vegetables. Access to refined sugars is limited because these foods can trigger cravings, particularly among alcoholics. Patients also are asked to limit caffeine consumption because of its jittery effect on the nervous system. Although different patients respond to different therapies, Sheehan says that biofeedback has proven to be an effective way to reduce the stress and anxiety that often accompanies addiction. Massage and progressive relaxation therapies also loosen muscle tension and promote a calmer state of mind, he says. Those in recovery are encouraged to incorporate quiet time, reflective readings and prayer into their daily lives.
While these calming therapies are vital, Sultanoff says, it’s important not to overlook the physical dimension. He recommends an herbal regimen to bolster addicts’ weakened immune system. Patients in his program, he says, have responded well to such immune-boosting herbs as echinacea, goldenseal, astragalus and members of the ginseng family. Additionally, acupuncture has been shown to reduce cravings, especially among smokers. And any touch therapy, from massage to craniosacral therapy, can help former addicts connect with their bodies and with other people, keeping at bay the isolation that can trigger relapse. Recovering addicts should also visit a nutritionist or naturopath to find out what’s best for them.
Yoga can be an important tool to reduce stress and anxiety. “It allows people to have an experience of deeper peace and quiet, a stillness that people never find in their daily lives of doing, doing, doing,” Sultanoff says. Flower essences can also ease depression or help release repressed emotions, adds Sultanoff, who benefitted from flower essences during his own recovery from nicotine addiction.
To beat addiction, it’s essential to fortify the mind and body. But recovering addicts who beautify their environments have an extra edge. In their book, Sultanoff and coauthor Roger Klinger advise people to improve their surroundings –especially since one of the common side effects of addiction is a neglected home. “Our charge is to help the recovering addict cultivate a taste not only for ‘clean living’ but for the kind of refined living that can help her heal her wounds and move along into sobriety,” they write. They recommend Feng Shui, the Chinese system of object arrangement, to emphasize the relationship between health and the home environment. Klinger and Sultanoff believe it’s possible to make big improvements with simple changes. Start by removing clutter. Then, examine your surroundings and replace disarray with beauty and “sacred order.” Creating a special place in the home or garden with momentos of good times or important relationships can become a place of refuge. Such sacred spaces and personal rituals are a powerful way to affirm recovery. Rituals don’t have to be elaborate or exotic ceremonies; they can be as simple as lighting a candle in the morning and saying a prayer for yourself or others. The key to a lasting recovery, Sultanoff says, is turning the process into a pleasurable experience that gives life new meaning.
JANE MERSKY LEDER, whose work has appeared in Woman’s Day, Good Housekeeping, American Heritage, and Psychology Today, specializes in health and psychology.