Substance Abuse and Addiction: It Could be You

Substance abuse is an ugly secret that no one likes to talk about. But it’s very real and it’s also extremely full of shame. When mentioning substance abuse most people think of illegal drugs, but the reality is the majority of substances abused are prescriptions.

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Substance Abuse and Addiction

Addiction is very complicated and multi-factorial. And, yes, it is a disorder. It is as much of a disorder as any other mental health condition or physiological condition. Substance use changes the brain–it effects the reward center of the brain and with time it becomes a need. Factors that contribute to risk of addiction includes genetics, type of substance, length/frequency of use, coping skills, etc.

Addiction can happen simply from pain medication use after a serious injury or surgery. There is a difficult balance between pain control and dependence and unfortunately addiction seems unavoidable. If a person is experiencing severe pain and requires an opiate to control it, if used long enough, it will create an addiction. This leads us down the rabbit hole of opiate abuse.

I’m sure you’ve heard the term “drug seeker”. I hate it. Working in healthcare I hear it all too often and it’s generally a label slapped inappropriately to someone with legitimate pain. Remember, you’re not the one in pain. There is absolutely no way for you to know if it’s “legitimate” or not. If pain medications end up being prescribed to someone who already has a genetic and/or social predisposition to addiction we find ourselves in a conundrum. Some doctors will give in and allow the person to maintain their dependence, some try to cut them off cold turkey. My stance on this is: even if the person is using their medication inappropriately we cannot suddenly end it. Addiction is evil and controls the wants/needs of your brain creating a horrible physical reaction to going cold turkey–aka withdrawal. Not only does addiction occur physically, but often psychologically as well. Substances can become a crutch for the person and are used as a a way to cope. Pulling that completely away leaves the person without proper coping skills, no support, and dealing with withdrawal symptoms. They need support. They need us to recognize their agony (emotionally and physically) they need us to help them understand their addiction. They need us to help them through weaning off the medication and provide resources for them.

Any of you can become addicted. You may just not have found yourself in that situation. And of course not everyone who abuses substances will become addicted. Have you ever gotten drunk? That’s substance abuse. Do you smoke? Addiction. Caffeine? Yup. It doesn’t matter the substance, it affects our brain the same. The same reward centers are used and the same responses occur. Cravings, dependence, withdrawal. It’s all there, but alcohol, nicotine, and caffeine are more socially acceptable. The difference between that and heroine, is the drug is a lot more deleterious and side effects are deadly. Not to mention legality. So how could someone get addicted to drugs? Ask yourself when you’re sipping that latte. You haven’t found yourself in the same position as the person who became addicted.

Desperation. A person who abuses substances is trying to escape, whether it be physical pain, emotional pain, anxiety, suicidality, fatigue…what is missing is healthy coping skills. The ability to manage the pain outside of substances. People who find themselves addicted to meth most likely haven’t developed appropriate coping mechanisms and most likely do not have support to help them through those difficult…devastating…moments. Imagine yourself feeling like your burning from the inside. Severe emotional pain and trauma. Vivid flashbacks of a rape, you keep reliving the moment over and over and over. You want out. You find something that can dull the memories, the pain. There is no one you can turn to, no one knows or would understand. Those you have reached out to tell you to get over it, it was 2 years ago. They tell you that everyone has experiences like that, it’s no big deal. The idea of opening up to a stranger, a therapist, is terrifying. Also expensive. Someone offers you a medication (legal or illegal it doesn’t matter). At this point you’ll do anything to rid of the internal torment. You find this medication dulls your memories, dulls the pain. Makes it more tolerable to be alive. Would you not want that?

Or maybe you had invasive surgery and find yourself in a lot of pain. You’ve been given pain killers, they work. They make it so you can halfway function, so you’re not writhing. Time goes on and you begin to heal, but every time you try to wean yourself of the pain meds the pain returns worse than ever. And because of tolerance you find yourself needing more to make it so you can work, you’ve used up your disability.

It’s easy. Given the right situation, anyone can become addicted.

If you find yourself or someone you love facing substance abuse and addiction, please seek help. You are worth it.

This is an amazing video. A neuroscientist explains addiction in a TED talk:

Anxiety: More than Nerves

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Everyone feels anxious sometimes. It’s completely normal and healthy to feel anxious before/during/after a life event. What’s not normal is when this feeling persists and begins to overtake your thoughts. Anxiety is more than someone overreacting, and generally the person experiencing it knows they are catastrophising, they just can’t control it. Sometimes feelings of panic come, seemingly, out of nowhere for reasons a person is not aware of.

I’m sure everyone has heard of “triggers”–especially due to the popular use of the term in the social justice warrior crowd. A trigger is something–anything–that brings back a memory or feeling of a traumatic event. This can be smell, touch, taste, words, sight…really anything. Often times the person is unaware that the trigger happened or what caused it. Sometimes there’s no trigger at all, stress in general can bring about the chaos of anxiety.

If anxiety is severe enough and unresolved it can result in a panic attack or anxiety attack. We’ve had numerous people come into the ER with symptoms of a panic attack thinking they are dying. Because it absolutely feels like it. A panic attack is a physical response to substantial anxiety that causes a person’s heart rate to increase, hyperventilate, lose concentration, disassociate, chest pain, dizziness, numbness…as a nurse I can tell you that a lot of those symptoms are secondary to the increase in heart rate and breathing. You can actually put yourself into what’s called “respiratory alkalosis” meaning the carbon dioxide ratio in your blood is skewed. This can result in serious physiological effects…and definitely makes a person feel like they are dying.

Please remember:
If you can’t relate to a person’s emotions or experience, this doesn’t make it any less valid. Your understanding of their experience is irrelevant to how they are feeling.

So what do you do?

-If you see someone looking panicked, catch their attention. While experiencing a panic attack the person feels completely out of control and letting someone know they are not alone can help ground them and bring them back to feeling safe.
-Get them to a quiet area. During a panic attack you feel completely overwhelmed and your environment can absolutely make this worse.
-Get them to breath. Slowing down breaths can get their attention on something other than their thoughts and physical feelings as well as keep them from hyperventilating.

Tips to preventing a panic attack or stopping it:

Believe me, I’m very well aware of the horrible sensation a panic attack creates. The feelings of being completely out of control and in immediate danger…yet not knowing why this is happening. However if you pay attention to your body you can start to recognize when an attack is brewing. You’ll notice feeling irritable, chest tightness, trouble concentrating, increased heart rate. Here’s what to do:

-Take time out. Find a quiet place where you can be alone.
-Breath. Take slow deep breaths. It helps to close your eyes and concentrate only on your breathing. I like to use the 5,6,7 rule. 5 seconds to inhale, hold for 6 seconds, 7 seconds to exhale. I cannot accentuate the importance of breathing enough! This is imperative to preventing and stopping a panic attack.
-It’s OK to cry. It’s OK to hurt. It’s OK to need to take care of yourself. You can’t pour from an empty cup. Let it out, gather yourself, and get back to what you were doing.
-If you can distract yourself by doing something you enjoy–a walk, music, scents…anything that’s calming to you.

Anxiety is a horrible feeling and coupled with depression, this makes for an ugly two-headed monster. Often both conditions cause a person to exhaust their ability to cope and self-medicating through alcohol and drug abuse can add a third demon to the already debilitating conditions. Depression, anxiety, and addiction are difficult to talk about separately because of the marriage between the three. To be continued.

Don’t be afraid to seek out help. There’s nothing wrong with medication–sometimes it’s the leg up you need to gain control over your mind.

You got this.

 

If you are feeling like self-harming or suicidal please call 911 or head to your nearest Emergency Room.

The 211 Helpline is available for crisis support. They are open 24/7 and are judgement free.

I love you. Please reach out if you need help. Hope does exist.

Depression: More than Sadness

I came across the idea of the “Black Dog” to personify depression years ago. I loved the illustration as I feel it captured well how depression feels in a way others may somewhat understand. You can watch the video here:

Depression is much more than feeling sad. People will often say they feel depressed or have felt depressed over a situational sadness. Everyone feels sad. Everyone has experienced grief. Not everyone knows the dark pit of depression.

Depression Statistics Inforgraph

Depression is a dark hole that a person falls into and seems to never be able to crawl out of. Depression is an all consuming fire burning the person alive. Depression is a large wave drowning you as you fight for your life. Depression is NOT a choice. One cannot simply “snap out of it”. “Just think about all the good thing you have”. “How can you be depressed, your life is so good”. “You’d feel better if you strengthened your relationship with God”. “You’re letting the devil control your life”. “You just need to ______”. Words I’ve heard over and over, and words that are so very far from helpful.

Depression is beyond situations…granted situations can make depression feel worse and situation grief or sadness can evolve into depression, but often it persists despite what is going on in a person’s life. Research into the cause of depression has shown it is a very complicated disease created from genetic dispositions and the way a persons brain is wired. I could go on and on about the neuroscience behind depression, but rather I’ll provide a link if you’re interested:

http://www.health.harvard.edu/mind-and-mood/what-causes-depression

Depression is defined in the DSM-V (psychology diagnostic manual):

Depressed mood or irritable– A person must feel depressed the majority of the time and can be subjective (reported by person) or objective (observed by another).

In my life I become very tearful and feel very empty. This is a consuming feeling and persists for days, to weeks, to months…to years.

Decreased interest or pleasure– A substantial loss of interest in what a person used to like to do.

One of my warning signs for heading into a depressive episode is that I start to lose interest in doing thing I normally love. I quit reading, I quit working out, I quit cooking, I start to just stay inside, I limit social contact, even my job seems difficult to enjoy.

Significant Weight/Appetite Change- Generally a change of 5% of body weight in 3-4 weeks.

For many eating is a coping mechanism. For me, I quit eating. I completely lose interest in food and things I normally love to eat taste bland and unappealing. In nursing school I lost 30lbs in three months because I couldn’t eat. I try to force myself when this happens, but with food not tasting well it’s hard to do.

Change in Sleep- Insomnia or hypersomnia. Can’t sleep or sleep way too much.

Mine shows up as insomnia. I cannot fall asleep and once I do I wake up constantly. However I’m always exhausted. Others sleep too much and struggle to stay awake.

Change in Activity- Psychomotor agitation or retardation. Think fidgeting too much or unable to move.

My depressive episodes are definitely mixed with anxiety so I will experience both. At times I cannot sit still. Other times I cannot move or move very slowly. I’ll walk slower and respond slower…sometimes it takes all day to take a shower.

Fatigue or loss of energy- I feel this ties in with the previous one. However the loss of energy is more than feeling “blah” or a normal “tired”.

At it’s worst I have to remind myself to breath. The loss of energy is so severe that breathing seems “too much”. Moving seems impossible…I’ll sit or lay in one position for hours…the entire time trying to convince myself to move. It’s as if your body is made of lead.

Guilt/Worthlessness- Excessive or inappropriate feelings of guilt and worthlessness.

Note: “Inappropriate”. Meaning irrational. Meaning the thought process and perception of the person is affected and you cannot reason a depressed person out of depression. Instead they often find themselves feeling very guilty for feeling the way they are. I will feel like I’m letting everyone down around me…I will feel useless, worthless. A burden.

Concentration- Indecisiveness, diminished ability to think.

Talking is difficult for me, I’ll struggle with expressive aphasia. Meaning I can’t get words out and I can’t get them out in the right order at times. When severe I can barely drive…I’ve almost wrecked my car many times because of this. It’s worse than driving drunk…you just cannot think right.

Suicidality- Thoughts of death or suicide. Has a plan.

If you’ve been following me at all it’s no secret this has been something I’ve definitely struggled with. And suicide deserves a post to itself. It’s a very complicated topic. For now I’ll explain that in these pits of darkness death seems to be the only way out. It’s not necessarily that the person wants to die, but rather escape.

To be diagnosed with Major Depressive Disorder one must possess 5 of the 9 symptoms listed above nearly every day for more than 2 weeks. The symptoms need to interfere with daily living-jobs, social life, relationships, etc.

Depression is often a co-morbid diagnoses most often with anxiety and addiction. Both of which I will touch on later.

Treatment for depression involves psychotropic medications such as SSRIs (Zoloft, Prozac, Celexa, Lexapro, etc) and therapy. I often tell people treatment is much like dating–you have to go through a lot of bad apples before finding “the one”. Not every medication is for everyone and neither are therapists.

If you haven’t had luck with therapy I’d encourage you to try again. Being able to connect with the person is very important and often therapy is unsuccessful because the relationship between the therapist and patient doesn’t mesh well. Therapy can help identify precipitating factors that cause depressive symptoms and help you rework the mis-wiring of your brain. It’s not a short term process nor a quick fix. Medications aren’t either. They can help, but do not cure. Ultimately you learn to live with your symptoms, learn to lessen them, and cope with them.

Anxiety and Substance Abuse/Addiction are next. Then we’ll finish of Mental Health Awareness Month with the difficult subject of Suicide and an overall discussion of coping skills, therapies, and resources.

If you are feeling suicidal please call 911, go to the ER, or go to your nearest behavioral health facility for an assessment. Your life is worth it. I promise.

Helpline 211 is also available 24/7 to chat or talk on the phone, they are here to help.