Quitting addiction to any substance, whether alcohol, cocaine, tranquilizers, heroin, tobacco, or one of the lesser known, is most frequently a very difficult process. Most of them are varied forms of the Alcoholics Anonymous "12 Step Program." Virtually all of them report at best 50% success and more commonly only 10% " sobriety one year from treatment. Dr. Neher has worked with several types of "treatment" programs and found that they lacked two important elements. He found that when they included these two in any of them, more than 90% maintained their sobriety after one year. It should be noted that tracking patients (or clients) longer is almost impossible to do on a regular basis. However, 95% of those few who had the benefit of the two elements and who have been able to be followed, maintained their sobriety for the next five or more years. This book covers these, two critical elements, in detail.
Altered States
The Inside Story of Excess and Successful RecoveryBy Terry NeherAuthorHouse
Copyright © 2011 Dr. Terry Neher
All right reserved.ISBN: 978-1-4567-3377-3Contents
Introduction.............................................................................ixChapter 1. Chemical Dependencies Defined.................................................1Chapter 2. The Disease Concept...........................................................3Chapter 3. My first Drink................................................................9Chapter 4. Dr. Neher's Short Story.......................................................15Chapter 5. How did I know this would work?...............................................21Chapter 6. Behavior Can Cause The Compulsion.............................................25Chapter 7. Chemical Susceptibilities.....................................................29Chapter 8. The Chemical Component to Thoughts, Feelings. & Behaviors.....................35Chapter 9. ADD/ADHD - MAYBE NOT.........................................................39Chapter 10. Nicotine Addiction...........................................................45Chapter 11. Beacons Of Compulsive Behavior...............................................47Chapter 12. A Brief Description of Neuronal Systems......................................51Chapter 13. The Function Of Dopamine.....................................................55Chapter 14. The Impact of Family Trauma..................................................61Chapter 15. Serotonin And The Monoamines.................................................63Chapter 16. Treat Brain Chemical Imbalance, NOT Symptoms.................................65Chapter 17. Benzodiazepine (Tranquilizer) Addiction......................................69Chapter 18. Contributions of Dr. Richard Andrews.........................................75Chapter 19. The Steps Toward "The Person You Wanted To Be"...............................79Chapter 20. Frustration With "Treatments" Currently Offered..............................81Chapter 21. What Is Effective Treatment?.................................................85Chapter 22. Meeting the Maslow Defined Hierarchy Of Needs................................89
Chapter One
Chemical Dependencies Defined
Let's begin with a discussion related to millions of Americans, chemical dependency. In the past, chemical dependency has been characterized by such terms as "character defects," "personality traits," and sets of behaviors identified as common to chemically dependent persons.
In reality, willpower and character traits have little or nothing to do with this disease. Instead, the necessary causal factors amount to chemical deficiencies, excesses, or imbalances in the brain. These abnormal chemistries occur as a result of genetic and environmental factors beyond the control of individuals. These altered chemical states actually become the precursors or factors necessary for a person to receive positive reinforcement through the use of externally introduced chemicals.
The way we think and feel, and behaviors that result, all happen because of chemical reactions/interactions in our brains. These chemical reactions are dependent upon balanced levels of many separate chemical molecules working together with specialized brain cells called "receptors" to produces thoughts, feelings, and actions. For every thought, feeling and behavior there exists a neurochemical equivalent in the brain. As a person continues to use external chemical sources to gain thoughts, feelings, or behaviors deemed desirable, he or she becomes "chemically" dependent.
In other words, for people to become dependent on an external Chemical source to produce the desired thought, feeling, or behavior, there must first exist, or be developed, a deficiency of a chemical component in their brains.
The first step toward an acceptable (for those people) lifestyle free from the need for external chemical intervention is, necessarily, abstinence from the use of these chemicals. This step, however, results in a set of dramatically uncomfortable and unacceptable thoughts, feelings, and potential behaviors as they attempt to interact in society with excessively curtailed brain-chemical capabilities.
This is the rationale for physiological stabilization as the necessary starting focus for recovery from chemical dependency. This focus is also what is lacking in many treatment experiences.
The major deterrent to chemical dependency counselors gaining a usable understanding of this process, we believe, has been the lack of practical interpretation of research findings into something we can use.
Chapter Two
The Disease Concept
Most in the treatment field espouse the disease concept because the American Medical Assn. has said alcoholism is a disease (AA calls it a "progressive illness"), and this makes the process "treatable". Those of us who are recovering believe ourselves to be of strong character and will, and readily accept the disease concept. Most non-recovering counselors voice the same acceptance but may, in all honesty, wonder to a degree about the claim.
In this society, a condition that meets four criteria may be termed a disease:
1. Etiology — factors that cause the condition are identifiable. 2. Symptomatology — identifiable symptoms, i.e, tolerance, blackouts, loss of control, etc. are present. 3. Morbidity — the symptoms describe a stage of the process. 4. Prognosis — in the case of chemical dependence, "guarded."
Now, if drinking alcohol was all it takes to cause alcoholism, for example, everyone who drinks would have the disease, and not nearly everyone does.
The etiologic factors being discussed, and the focus of this writing, are neurochemical and enzymatic. We are not discussing in depth here those liver enzyme levels and activities we know to be very important.
Approximately 50 substances naturally produced by the brain have been identified as neurotransmitters of thoughts, feelings, and actions (there are probably over 200 neurotransmitters not yet identified).. Of these, several are of special interest in chemical dependency recovery, and — very importantly — they can be identified with certain emotional states. This allows us to greatly simplify and make usable an understanding of neurochemistry.
Lets look at some of these neurochemicals and the associated thoughts, feelings, and behaviors.
Opioids — endorphins and enkephalins — are substances used by The brain to moderate pain—physical and psychological. Endorphins (endogenous morphine-like substances) seem to work to moderate physical pain. Enkephalins (met-enkephalin and leu-enkephalin) appear to have a profound effect in those neural areas associated with emotional memory. What is the most painful emotional feeling we suffer? "Low self worth!".
As a result of replicated studies, we know, for instance, that opioid levels can be influenced by genetics and/or trauma (stress). When a person's opioid availability is low, due to genetic susceptibility or unmanaged environmental trauma, that person feels incomplete, inadequate, and unworthy, due to decreased enkephalin availability. Inherited deficiencies of these chemistries are likely the cause of extreme shyness in children. They may never feel equal to their peers, regardless of reality. They always feel "second or third," never "first" or "as good as" others. When the levels of these chemistries are adequate, such as following nurturing by a parent, for example, which increases the release and utilization of endorphins/enkephalins, a child feels internally focused and calm, and has a sense of completeness. Sustained exercise releases opioids, and the person feels calm, centered, and complete ie.-euphoric.
Opiate drugs, legal or illegal, will fill these same receptor sites and produce the desired feeling of well-being. Alcohol metabolism and the eventual production of salsolinol provides the molecule that will fill enkephalin sites and increase feelings of well-being. Beer drinkers get a double dose of enkephalin replacement because, in addition to alcohol metabolism providing salsolinol, this chemical is naturally present as a result of hops fermentation in the production of beer.
Dopamine functions in areas associated with reward, pleasure, and altruism —in the frontal lobe of the brain, for instance- as well as maternal and paternal feelings associated with the limbic system. When dopamine is depleted, as in cocaine or methamphetamine use and addiction, inadequate neurotransmitter is available in these areas to produce these feelings. Consequently, addicts can not feel remorse about their actions and can not experience maternal or paternal concerns. When confronted with child neglect or abuse, for example, they typically will say they know they should care but just "can't" seem to.
Norephinephrine (NE) is produced from dopamine and is the brain's energizer/arousal neurotransmitter. When adequate norepinepherine is available, a person feels energetic, motivated, and full of "drive." If NE is lacking, a person has no energy, lacks motivation and drive, and feels "depressed".
Serotonin is the brain's emotional stabilizer. When adequate serotonin is available, a person has rational, balanced emotions. If serotonin is decreased — during premenstrual cycle, for example, or from prolonged periods of lack of direct sunlight- a person feels irritable, on the verge of tears for no reason, and can't sleep well; noises bother that individual more than usual. He or she lacks rational emotions and feels "depressed". If someone is depressed, and this depression has an aspect of irritability, then serotonin is likely low.
GABA accounts for up to 40 percent of the brain's neurotransmitters. Think of it as functioning in stress management. When adequate GABA is available, a person feels calm. When insufficient GABA levels occur, a person feels anxious for no identifiable reason (free-floating anxiety) and can experience panic attacks and eventually convulsions. GABA depletion is a major factor in delayed stress syndrome, and GABA complex depletion may contribute to various phobias, (along with serotonin depletion).
Alcohol, barbiturates (sleeping pills), and benzodiazepines (tranquilizers) all attach to GABAergic neurons and enhance the binding of GABA allowing increased chloride ions to enter the neurons, decrease firings, and producing calmness and a sense of stress reduction by reducing the fight-or —flight response.
Some enlightening studies have been published concerning enzyme and certain hormone functions. When blood samples of people involved in alcohol abuse or alcoholism were infused with the alcohol equivalent of approximately 4-6 regular drinks, regular beers or standard table wine (2.5 oz pure alcohol), certain enzymes were dramatically impacted. When control samples from individuals with no alcohol problems were tested in the same way there did not appear to be a similar impact.
One of these enzymes, monoamine oxidase (MAO), was functionally depressed, or slowed down, when contacted by the alcohol molecule in those persons drinking heavily. What can this mean? This one example significantly answers the question, "why do certain people feel energized and more alert and positive by the depressant drug alcohol"? The monoamines affected are dopamine, norepinephrine, and serotonin. MAO functions to reduce the levels of these neurotransmitters. When MAO is inhibited by alcohol, the activity level of the monoamines will increase. The result of this is increased feelings of energy (NE), increased feelings of pleasure (dopamine), and increased feelings of emotional stability (serotonin). People gaining this effect as a result of MAO inhibition feel more in control, more positive, and less depressed at four to six drinks (or the equivalent in beer or wine). This is the benefit of gulping drinks for persons susceptible to this enzyme alteration.; the quicker they get to the effective level inhibiting their MAO, the sooner they feel positive effects. MAO inhibition is also a primary factor in elevating blood pressure in susceptible individuals.
In these same studies, cortisol function was found to be lowered by the alcohol in blood samples of alcohol abusers and alcoholics. Cortisol is used by the brain to monitor threatening situations, making ready for fight or flight. When susceptible individuals lower their cortisol function with alcohol, they sense "no threat present," no uncomfortable feelings of concern, and no reason to stop drinking. In people not experiencing this effect, their brain responds to the alcohol as a toxin and increases cortisol availability, making the person "uncomfortable" enough to reduce or stop drinking.
Using these few examples, then, we could say that if genetically Susceptible individuals, or those who have altered their biochemistry as a result of trauma or unmanaged stress, feel more assertive, more active, less depressed, a greater sense of pleasure and calm, more stable, and more in control when they drink, and do not sense a threat from alcohol, why wouldn't they drink? THEY DO!
At times we hear various individuals say something like "he or she is 'too far gone' to recover. They have tried over and over and just can't seem to stay away from their "drug of choice" that has always resulted in increasing problems.
To that I say "oh yes you can"!! Let Shawn tell her story of addiction and recovery.
Chapter Three
My first Drink
"The first time I ever drank I was about 2 years old. My sister got into my father's liquor and fed booze into me. From what my dad now tells me, he used to give my sister and I sips of their drinks (when we were 3 and 5) as they partied with their friends and neighbors. They all thought it was amusing to watch us get buzzed.
My first conscious memory of drinking was when I was 15 and a half. Seemed like that must have been pretty important to me at the time, since the 21 year old boy that ended up raping me when I was passed out and covered in vomit, kept bringing it up to make fun of me. My girlfriend Jill and I got into her parents vodka and made ourselves vodka and Tang cocktails. Most of the evening was pretty fuzzy, but I remember feeling pretty grown up to be hanging out with Jill, her older brother who was on leave from the Navy, and one of his skuzzy friends the rapist. Her parents were out of town for the weekend. He took my virginity and left me with a badge of shame that I wore, hidden, for decades. I woke up with my pants undone and not all the way back on, blood on my thighs, and venereal warts.
The STD (sexually transmitted disease) that I contracted as a result of this encounter is what, I'm sure, caused my cervical cancer, the cancer that scarred my uterus and caused my daughter to be born so prematurely.
Some of my other memories of drinking include getting into my folks liquor cabinet and taking a little bit of all the bottles and pouring it into a container, to take with me to Skateland. I must have been in 9th grade. I'd hook up with a couple other kids who did the same thing and we would meet at the school and ride the bus together to Skate Night. We would sit in the back and sneak drinks.
What I learned about drinking right away, was that when I drank any alcohol I felt like I fit with the crowd. It was the only time I felt that way. I discovered that when I put alcohol into my body, I was no longer the shy geek, the ugly duckling, the girl on the fringe of the crowd, wanting so desperately to fit in but knowing I just didn't.
I never felt like I was good enough to be hanging out with whoever it was I wanted to be around — I felt "less than", inferior, like a hanger on, an imposter. I always felt like I had to buy my way in so I would provide the car, the gas money, the booze, the food, whatever. On my own I just wasn't good enough.
When I started drinking, I hated myself the next day for how I'd behaved. I wanted someone to stop me, I wanted my parents to intervene, show me they cared enough to know how confused, miserable, scared, full of anxiety I was. But when I did get confronted, either with the pile of beer caps my dad found in the car, the extra hundred miles or so I put on the car when I was just going to go "to the game", or the way I tried to sneak in hours past my curfew, it was never what I needed. It was either raging violence from my dad, who was then so sorry in the next few days that he dropped whatever consequence he had handed out, or even worse, bought me something to make himself feel better. A new car, a bike, tickets to a concert.
Then there was my mom, who taught me at a very early age that we must keep secrets. We weren't going to tell dad. She knew I "didn't mean to do" whatever it was that I did, and she knew I would be "better" next time, so we just won't tell dad. No need to make him upset. It wasn't that we were "intentionally" deceiving him, it was just that he was so busy, he loved me so much, there was no need to involve him since she "knew" it wouldn't happen again.
In my early 20's alcohol was still my "drug of choice" but I may have experimented with other "things" when with friends at a party. My memory of my life from 20 until I was almost 33 is very vague and I still only get bits and pieces even when prompted. My first real run-in with the law did not happen until I was about 25. I had been drinking "Long Island Ice Tea" (a combination of at least 4 liquors and pepsi or coke that taste like tea), several of them, got mad at my friends, got in my car and left. Very soon I was pulled over by a police officer for weaving over the center line. I remember I had on high heels and he told me to walk a line in the gravel, which I refused to do. He told me he was going to administer a "breathalyzer" which I refused, and I got belligerent. I recall several officers grabbing me and forcing me against the police car and while they were attempting to handcuff me I grabbed one of the officers between his legs and started yanking. They proceeded to forcefully restrain me and took me to jail.
I went before a judge and was "sentenced" to an "alcohol awareness class" for DUI offenders. This consisted of some lectures about the evil of drinking and I was required to meet 1 on 1 with a counselor each week for 4 weeks. After the first counseling session the counselor offered me cocaine. The next week we met at my house and used cocaine again. His behavior became very bizarre and as soon as my "required" attendance was done I got away from him.
(Continues...)
Excerpted from Altered Statesby Terry Neher Copyright © 2011 by Dr. Terry Neher. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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