Author: Kathy Willis/Thursday, December 10, 2009/Categories: Addiction Medicine
Thirty years ago, when I first started working in addiction treatment, the average patient was middle age, white, male, employed, with intact family and alcoholic. At the time, about 15-20% were women, usually alcohol and/or Valium addiction. The patient population was usually late-middle to late stage alcoholic, often had prolonged and medically challenging detox and difficulty concentrating in lectures. We did occasionally check to see how our ex-patients were doing but statistically valid studies were rare.
Today, I feel that I am providing treatment to the grand children and great grandchildren of these early patients. Addictive disease is like a bomb going off in a room; everyone is hit with flying fragments of the addiction bomb. With each generation that passes, the trauma increases but unfortunately, trauma and the impact on the brain often does not become a part of treatment. Our population in treatment today very frequently have dual disorders; personality disorders, major problems with anxiety, depression, stress and anger, process addictions such as eating or restricting, gambling, shopping, internet and pornography, and most of all post traumatic stress disorder.
We have understood for many years that addiction runs in families and that the genetic sensitivity sets family members up to have this disease themselves much in the same manner as other chronic disorders and/or diseases in a family. What we have not looked at enough until lately, are those family members who are not born with this genetic sensitivity but still develops the disease of addiction. I am suggesting that an additional reason that this disease runs in families is the stress and trauma that children experience growing up in a family with addiction. Even the adult children of alcoholic/addicts, who do not have addiction, may have developed patterns of emotional behavior that can negatively impact their children, and set up the brain for drug addiction. Trauma, which causes a stress reaction, is often created when one or both parents (or primary caregivers) have addiction, mental health issues and/or rage issues. The children of this stress or trauma often do not know they have been impacted and tend to believe they will be “OK” if they leave and create their own families. Trauma has been shown to change the structure and chemistry of the brain. These children then pass on to their children both the trauma and the fragmented intimacy issues they developed as children.
Expressions of trauma include; emotional detachment including dissociation or “numbing out”, dissociation leading to a person seeming emotionally “flat”, preoccupied, distant, or cold, super controlling, hyper vigilance and anxiety and sleep problems. The brain uses epinephrine to execute autonomic and neuro-endocrine responses serving as a global alarm system. The autonomic nervous system provides the rapid response to stress known as the flight-fight-freeze response. The interactions between the mental state, nervous and immune systems can impair developmental growth in children, which later can alter their perceptions of, and reactions to stress.
Anxiety is the response of the organism to a threat, real or imagined. Objective manifestations include increased responsiveness, restlessness, and autonomic nervous system changes such as increased heart rate and blood pressure. There are important differences between acute anxiety and chronic anxiety. Chronic anxiety often strains or exceeds an individual’s ability to adapt to it. Chronic anxiety is fed by a fear of what might be.
All human beings have a primal drive towards pleasure and away from pain. With a brain that is anxious, depressed, always in “alert” mode for some un-named danger, the initial effects of a drug, alcohol, marijuana, opiates or cocaine, give the user an initial euphoria not previously experienced. This experience is recorded in the limbic system as a “good thing”. Away from pain, towards pleasure. Memory of past trauma or traumas is quieted, hyper-arousal is, for the moment, quieted, and fear recedes. The most natural thing would be to repeat the experience of drug taking to re-experience the relief of stress symptoms
Now, with one alcoholic with four children, we may have 2 of the children with addiction; perhaps one genetically sensitive and one whose brain changes are the result of the stress of living with the uncertainty and fear of an alcoholic parent.
Only a small percentage of people with addiction receive treatment. When they do go to treatment, they receive on average 28 days of treatment and then return to the same environments from which they came. We now know that not much changes in the brain in 28 days, that we need 90 days to be of real help. In the last 5-7 years, there has been an explosion of information regarding addictive disease as a Brain Disease! However, even in the face of new information, most of us are using the model of emotional/behavioral approaches to treatment. I am not saying this is wrong but I am saying that before applying emotional behavioral solutions, we need to TREAT THE BRAIN-FIRST.
We have for many years asked people to sit and listen to lectures and sit in process groups while they work on written assignments. There is nothing wrong with this approach but we need to first help the brain and body to heal for this approach to be effective.
People with anxiety have developed a changed manner of breathing in a shallow way. They are continuously breathing in a manner that deprives the brain of necessary oxygen. In addition, they often use food for comfort with extremely high levels of sugar, which increases blood pressure, causes the body to work twice as hard and can have a harmful effect on the brain. Their diets often don’t contain necessary nutrients and they often take very few, if any, supplements for brain building. It is almost impossible for a person to learn and apply what they have learned with a brain that is anxious about the loss of the chemicals it has learned to rely on, while simultaneously experiencing the pain of withdrawal and post acute withdrawal.
The Three Legged Stool for Brain building
In addition to traditional treatment these are the activities that help the brain begin to heal in a significant manner.
First, clients need to detox from not only the addictive chemicals that brought them to treatment but also from sugar and caffeine. The diet needs to be only extremely low on the glycemic index, but fresh food instead of frozen or canned. Items such as potatoes, white breads and flour, sweets of any kind, should be removed from the daily diet. All items with caffeine should be removed.
Second, the use of an exercise designed to help clients learn to breathe from the belly and practice some form of aerobic breath needs to be a part of a daily regimen. At Malibu Beach Recovery Center, we use yoga and a very special style of yoga breath three times daily in addition to traditional treatment methods. Whatever a facility designs around teaching breathing, it is central to helping to heal the brain. Because this is a dramatic change for the body, resistance to this exercise should be expected. The body will fight what it is not used to. It is possible to achieve an aerobic workout through breath work alone which means that even people with physical challenges can participate. Closing the day, the use of meditation is extremely helpful.
Third, we can all become more knowledgeable in the use of amino acids and natural supplements that provide amazing help for the brain to heal itself from the assault of stress and chemicals used over many years. There are so many good authors of help in this area. I recommend starting with books by Julia Ross, “The Mood Cure” and Dr. Hyla Cass, “8 Weeks To Vibrant Health” and, “Natural High” but there are many good books on this subject. Supplements are something a physician, working with clients in treatment will want to be in charge of as they should be used with careful diagnosis and monitored in the early stage of treatment.
I have been calling this unique approach of supplements, yoga and yoga breath and low glycemic diet, “A SPA FOR THE BRAIN”. In my thirty plus years of working in the field of addiction, I have never seen such vibrant health as is produced by this “three legged stool”.
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