" Cognitive Behavioral Therapy (CBT) is considered the most effective treatment for stimulant addiction. No medical treatment currently exists for stimulant addiction, which include methamphetamine and cocaine. At the MATRIX Institute on Addictions in San Bernardino, CA, methamphetamine and cocaine addicts attend evidence-based (proven effective) behavioral therapy groups. The program includes participation in weekly recovery skills groups, individual and family counseling, drug testing and 12-step or other mutual support groups."

Read the review by clicking on the “Read More” below…

You can see the whole interview on the HBO: Addiction website by clicking here. Next to the video, you will see three chapters that are clickable links and these will give you access to the whole interview in roughly 10 minute segments.

The lead-in of “No medical treatment currently exists for stimulant addiction” would seemingly set the stage for the HBO documentary to take on the mother of all addictions. While it’s a true statement and certainly great theatre, it is very misleading. The facts are that really no medical treatment exists out there to cure any addiction and the treatments that do exist are more maintenance programs that have just as miserable failure rates as any other method. It has been my experience that the severity of the addiction and the potential for recovery is dependent upon a person’s health, environment, and available support structure much more than the type of addiction they have. So lets get back to the review, knowing that all addictions are chronic by definition and that any substance or habit can be deadly when taken to the extreme.

This segment of the documentary centers on a group meeting attended by four people addicted to stimulants. They have a counselor leading the session, but once again I am impressed with the way HBO has presented the material because it is not the group leader who explains the occurring events. Instead, it is the Director of the Matrix Institute that explains the ongoing events of the meeting and how they relate to cognitive behavioral training (CBT). The reinforcement of information given in small, easy to grasp segments has been a recurring method of this documentary and it plays a major factor in my ability to grok the message. Kudos HBO.

Excessive use of stimulants causes the decision making portions of the brain to become almost nonfunctional. A stimulant addict must be trained to both think and react differently. “CBT is a set of techniques that helps you learn day to day how to get sober and how to stay sober.” Basically, CBT is training to recognize the “triggers” of stimulant use and developing behavior patterns to not only stay away from these situations but to ultimately change the way in which one reacts.

CBT is teaching and coaching as opposed to therapy which is more of a long term approach to why you became addicted and how you can stay sober. Behavioral changes are made to immediately help you get out of the rut of addiction and stay away from those things that may cause you to relapse. Anehedonia, the inability of emotional gratification caused by damage to the neurochemical system of the brain, mentioned earlier in the Brady interview is discussed once again as a major factor of relapse. The Matrix Institute uses brain imaging to explain this process and as an aid in helping those in the first few months of recovery understand why they feel so unhappy. Prolonged use of stimulants has stunted the production of dopamine, the brain’s natural reward system, and it can take 4, 6, and even 12 months before the brain reprograms itself to start producing dopamine again.

Compulsory treatment is thought of as successful by the Matrix Institute, and in the manner they explained this I had to agree. I know, I know… many of you here know that I usually cast a jaded eye toward compulsory treatment. However, it seems that the Matrix Institute is likening those in mandatory treatment that would like and are eager to get help with those in the program that care little about entering recovery and only in staying out of jail. It is the latter that I am adamant that treatment is a waste of resources.

My eyes are growing heavy so I am going to have to bring this review to a close.

CBT seems to be an effective manner of helping those with addictions enter and stay in recovery. This method can be reinforced with 12 step and group therapy to be more effective, but a recurring theme through all these types of treatment is the establishment of routines. Routines make us feel safe and stable, good routines keep us active and away from trouble, and best of all long term routines lead to success in life.

Any step toward recovery is a good one whether it be CBT, AA, NA, or cold turkey, but the ones that work best are usually the ones that have the most support. Good night all.

Technorati Profile

"Dr. Kathleen Brady is a professor of psychiatry at the Medical School of the University South Carolina, and an expert in addiction and co-occurring psychiatric disorders. Here she discusses how underlying disorders like anxiety, depression or trauma can lead to addiction or relapse, stressing the necessity of treating these mental disorders and addiction simultaneously."

Read the review by clicking on the “Read More” below…

You can see the whole interview on the HBO: Addiction website by clicking here. Next to the video, you will see three chapters that are clickable links and these will give you access to the whole interview in roughly 10 minute segments.

As in the case with Dr. Volkow, I am impressed not only by the obvious grasp of the subject matter that Dr. Brady has attained but also by the way her interview is filmed. Her topics are presented in short, to-the-point segments introduced with a black and white text that is all wrapped up in a similar summary at the end.

She begins by giving her definition of addiction; a compulsive use of drugs and/or alcohol. She goes on to explain the steps of experimentation, casual use, and then abuse that lead up to an addiction and the genetic predisposition and environmental factors that also can play a role. Most of this information I have heard from other sources, but the way it is delivered here is quite effective.

Definitely more interesting was the topic of anehedonia, which is a condition that impairs one’s ability for emotional gratification and is caused by the reduced dopamine (the brain’s neurotransmitter and natural reward system) production of an addicted brain. Actually I have heard this term mentioned, even in conjunction with the fact that alcoholics and addicts have reduced dopamine production because of their reliance on drugs and alcohol to serve as a proxy service for an emotional reward system. However, I had never caught on to the fact that this is not only a major cause of continued drug and alcohol abuse, but also a major cause of relapse.

An example: When a mother sees her child, dopamine is produced and the result is a positive emotional reward. A mother gripped by addiction will not have a similar bond with their child because the same emotional reward can only be gained from drugs and alcohol. So in the first stages of recovery, many become depressed because it can take several months of abstinence from their drug of choice before their brain begins producing dopamine normally. The mother who is now in her first weeks of recovery still may not get a normal emotional award from her family interaction and can easily fall right back into using again.

This is kind of the neurochemical explanation of the “high” that many get from becoming clean and sober that is all too often transformed into a depressive state after just a few weeks of sobriety. The “high” comes from the stress relief and physical rejuvenation one usually experiences when they switch from 24/7 abuse to taking care of themselves. However, without the dopamine reward systems functioning properly they very soon find them self in a depressed state and searching for something to give them “meaning” once again.

Now you can see why as a psychiatrist she is very interested in the co-occuring problems of depression and anxiety. She stresses the simultaneous treatment of the addiction and the other problems, but does not really delve too far into the issue that one may just be a symptom of the other. I think the reason for this is that there is only so much you can try to explain in a twenty minute interview, but the introduction does stress that this is her specialty. But to be fair I do not think I would want to touch that topic if I had a full semester either, much less with just a few minutes to get my point across.

I’ll let her slide on this one, but submit for discussion the fact that I and almost every addict and alcoholic I know that had access to the head doctors also convinced them that we were manic depressive, bi-polar, and suicidal. We did this in a manipulative manner not in the search for solace, but in the hunt for drugs and reinforcement that our problems were unique and not “just and addiction”! Once we got what we needed, it was time for another doctor, another script, and a life that was already destroyed by the drug of our choice was now muddled further by those prescribed to us by (usually) well meaning professionals.

I will cover the other points that I disagree with Dr. Brady in another segment because this is getting rather long winded. I will leave you with my topics of contention for those of you that may want to blog on the subject. 1) I disagree in principle with Dr. Brady that one need not hit “rock bottom” before they can begin recovery. 2) I also disagree in principle that non-voluntary treatment is effective. I say in principle not because I think she is wrong in the clinical sense, just that reality and the support resources an average person can command almost always bear truth to these rules.

Good show, I am looking forward to watching and reviewing more of this well done documentary series.

It may feel like the laws of the universe have ceased to exist once you have a month or two of sobriety under your belt after a lifetime of drinking. Be warned though, although it may seem like a brave new world to you, the rest of the world goes on as if nothing has changed.

A forty-one year old Las Vegas resident working through AA's Step 9 recently found this out the hard way. Click here to read the whole story in the Las Vegas Weekly. William Nottingham Beebe found sobriety "sobering" when he learned that just because he's ready to make amends doesn’t mean the victim he allegedly raped in college is as ready to forgive him!

Click the "Read More" to see the rest of the commentary

"In October, 1984," he wrote, "I harmed you." He invited Seccuro to contact him "anywhere, at any time, with anyone," and included a business card. "My prayer," he wrote, "is that you be free and happy in your life."

He sent the above message on vanilla scented paper of all things, nothing like trying to soften a rape confession with a little aromatherapy! Anyone who has worked the steps knows that you have to honestly work them to get anything out of them, but it doesn't hurt to use a little common sense either. Even if this heinous act he committed over twenty years ago was a principal source of many of his problems, the Big Book tells those working through the steps to avoid carrying through with actions that may "when to do so would injure them or others". It doesn't take a lot of cognitive power to figure out that writing vanilla scented "I'm sorry I raped you" greeting cards would bring a world of pain to all involved.

One of my friends says I am being a little harsh on the guy, who he says was just trying to work his program. I disagree, most of us as alcoholics and addicts have gone through our lives hurting others with our selfish and often mindless behavior. When we finally decide to reverse this course and discover a new way of life, we should realize that the laws of the universe have not been suspended just because we have decided to get sober.

Beebe has been arrested and faces life imprisonment and his victim is left wondering why this idiot opened wounds long healed.

Thoughts anybody?

”… it turned out that everything I put down on paper was eerily similar to the same thing I had heard in rehab”

When I was about 2 or 3 years into my recovery I had convinced myself that I knew everything there was about staying sober. I just “knew” AA was a crock and that the only good thing to come out of a 12 step group meeting was free coffee. I went so far as to say that I was going to write a book, to tell people that I had the answer to all their problems. Then reality set in… it turned out that everything I put down on paper was eerily similar to the same thing I had heard in rehab, AA, NA, and group meetings of all sorts.

Fast forward to a decade later and the only thing I can tell you I am convinced of is that I can recommend almost any recovery program. I will not call it wisdom because of that particular trait I am definitely lacking, so call it hard earned experience that convinced me of this; regardless of your method of attainment, sobriety beats drunk in all races.

I think it was just a phase I went through where I felt I needed to judge the different recovery methods and programs. Little did I know back then that the problems I faced in attaining sobriety were light compared to others or may have been considered insurmountable by some, but there definitely can not be a single solution that fits everyone's needs. Alcohol, drugs, or both… the symptoms of the addiction remain similar but the unique trials and tribulations of one’s life are unique to their situation. Some need more support and others need less structure, but everyone is better off in recovery regardless of the methods.

The more I talk to others in recovery the more I realize that the recurring threads of reality, accountability, and spirituality run through all the programs of recovery, even in those that do it “on their on”. I don’t know why I felt the need to criticize the methods of others, but it takes only a simple Google search to see that many others spend a considerable amount of time trying to debunk recovery programs that obviously didn’t work for them. I hope that like with me, it’s just a phase that will pass and that eventually they will spend less time being negative and more time concentrating on their own success.

 “Science has shown that the brain has a remarkable ability to recover from addiction. With continuing advances in medical and behavioral treatments, addiction will soon be commonly accepted as a manageable chronic disease.”

This summary statement is displayed at the end of the 30 minute interview with Dr. Nora Volkow, Director of the National Institute on Drug Abuse, done by HBO in its series on addiction. I agree whole heartedly that the brain has the remarkable ability to find ways around the damage caused by prolonged drug and alcohol abuse. However, the premise that addiction will soon be commonly accepted as a manageable chronic disease seems a little far-fetched to me.

Read more below the fold…

You can see the whole interview on the HBO: Addiction website by clicking here. Next to the video, you will see three chapters that are clickable links and these will give you access to the whole interview in roughly 10 minutes segments. This portion of the series was done by Liz Garbus whose bio you can find here.

In an informal therapy group, Dr. Nora Volkow, Director of NIDA, discusses addiction as a brain disease with addicts and family members. She notes the environmental, behavioral and genetic factors that can make an individual vulnerable to addiction and how the disease leads to abnormal behavior. Additionally, Volkow uses brain imaging to illustrate how drugs and alcohol physically alter the brain, which is important in understanding addiction. Addicts are incorporated into this program as they share their difficult struggles with the disease.

Other than my previous comment about the near future acceptance of addiction as a treatable disease, I thought most of what Dr. Volkow had to say was right on the money. Early treatment works best, relapse is common but not failure, and the need for longer treatment periods all ring true. However, I think one needs to be careful when treating depression or other less than absolutely severe mental conditions during the first stages of treatment, especially with other drugs. It is the humble opinion of this writer, and I know I will raise some hackles with this statement, that all addicts and alcoholics are depressed… mostly because they have an addiction and their life is in the crapper! Treat the addiction first; detox and then recovery for a while before a diagnosis is made for chronic depression.

One thing that is not just my opinion is that all alcoholics and addicts are looking for that certain something they can rely on to get them through life, anti-depressants fit this bill quite admirably at first but often lead to other and illicit self medication. If one is in recovery, yet still reliant upon drugs, it is very difficult to change the “mode” of one’s thinking. I call it thinking like an alcoholic. If this is just a short term solution, such as in methadone maintenance, it should always be referred to in this way by both doctor and patient.

Let me know what you think of the video segments and feel free to make any suggestions about how I am reviewing this great series. PS: Dr. Volkow is the recipient of the first ever TDA Salute.

How do you explain to someone, who has never been personally cursed with an addiction, the overwhelming desire for your drug of choice.

The normal person cannot fathom the act of forsaking family, friends, and dignity in order to fulfill the demands of an addiction. My father who has two alcoholic sons (one is yours truly) is one of the smartest and most compassionate people I know, and he still lacks the capacity to understand how his sons were not able just “to quit”. In order to explain this absolute demand an addiction makes to my father, I resort to the use of an analogy of a drowning man fighting for air.

Click “read more” for the rest of the story…

In many ways it is a very apt analogy. They say a drowing person taps into the instictive fight for life and will drag his best friend under the waves in order to get to the lifesaving air above. The same is true for alcoholics and addicts, we will drag our our spouse, children, family, and friends down to the bottom with us because the NUMBER ONE PRIORITY in our lives is our alcohol and drugs. Many times I hear in meetings from people actively using that “I’m still a good husband” or “My children are my world”, but I know it is nothing more than a lie they are telling themselves. The addict or alcoholic that is using may still be able to take care of their family or job requirements, but it is only after they have satisfied the demand of their addiction. When times are bad and the choice has to be made between a drug of choice and other issues in life, you will become rich by betting that drugs and alcohol will be picked first.

I will post this story again in the future when we have more users to see if other members have a better way of explaining an addiction to those blessed not to know what it feels like.

I am impressed. While I disagreed with a few things that were said by the medical professionals, the overall tone, tempo, and consideration of the first in this series was admirable.

I did not subscribe to HBO before tonight, so I had not seen any television advertisements prior to its showing. The only preview scenes I had seen were from the the website, which by the way, is well worth the vist. You can visit the site here:

Website for the Addiction Project by HBO

More below the fold…

The small clips from the website contained calm commentary by alcoholics, addicts, and doctors that had me hopeful that the documentary would not be rife with the emotional and embarassing outburst that A&E uses to tout its Intervention series. While I think the A&E series can impart some very useful information and may be helpful, especially to the family members and loved one’s of those with addictions, I feel they use the teaser clips of shocking behavior to draw in more of an audience looking for a voyeurism experience than learning about addictions.

One problem with the presentation I have is that it is going to string out many of the individual stories throughout the series, which may make it difficult for those of us with busy schedules to follow them contiguously. While the information will be valuable even if you see these stories out of order, the emotional investment you have in them as individuals will not be the same. I’ll save the content discussion for a later date, I tried to jot down many of the drugs they spotlighted as being helpful to addicts and alcoholics so I hope that I got their spelling close enough that I can do a little research before we discuss. This is a touchy point for many, including myself, using one substance to help overcome an addiction to another. A battle for another blog but I will leave you with this thought; any move toward recovery is a move in the right direction

HBO will begin a 14 part documentary this weekend on addictions. If the content lives up to the hype and marketing it could very well be a worthy project.

I plan to watch and report as the episodes air.

I understand that many cable providers will be offering a free preview of HBO while this documentary is airing.

It is rare that I feel the need or even find the opportunity to praise someone in the entertainment industry, but Craig Ferguson of the Late Late Show really knocked one out of the park last week with a monologue about alcoholism.

More below the fold…

Showing true talent as well as compassion, Ferguson explains why he will not make fun of Britney Spears in a revealing display of introspection that was emotionally moving as well as just plain funny. He seems to be working through the steps of his own recovery right there live and in front of the audience. I urge you to watch this and since it’s a YouTube clip, please send it to others that may also benefit from seeing this.

I got sober. I stopped killing myself with alcohol. I began to think: ‘Wait a minute – if I can stop doing this, what are the possibilities?’ And slowly it dawned on me that it was maybe worth the risk.~ Craig Ferguson