2015 November

Addiction 101 (Alcohol)

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Human beings have been using various substances to alter their brain processes for tens of thousands of years. The Latin root of the word intoxicate means “to poison” and this is literally what many of these substances do. Although moderate consumption of most drugs (including alcohol) may cause no permanent damage to our bodies or to our brains, it is clear that excessive use can have severe consequences. For those who have the genes for addiction, the consequences can be even more far reaching.

 

It has been commonly believed that alcohol kills brain cells, but this is not, strictly speaking, true. It is the case that years of alcohol abuse can cause serious neurological damage, including Wernicke-Korsakoff syndrome, which can lead to motor, memory and vision problems, and even death. There can also be damage to the message-carrying dendrites on neurons in the cerebellum, a part of the brain which has to do with learning and physical coordination. Physical effects can include liver disease, damage to the fetus, pancreatitis, gastritis and several forms of cancer, to name just a few.

 

For those individuals who possess the genetic predisposition for alcoholism, chronic, compulsive long-term use may occur and produce some of the negative physiological effects listed above, in addition to seriously damaging our intimate and social relationships, educational endeavours, and employment. We may also place ourselves and others at increased risk for violence and injury.

 

In the addicted brain, alcohol actually highjacks the function of the neurotransmitter serotonin. This is often characterized as the “happiness circuit” and when there is not enough of the neurotransmitter making the connection, depression can result. Alcohol is attractive to the alcoholic brain which actually prefers, or more easily accepts alcohol than it does serotonin. As we all know, alcohol is easily consumed and acts very quickly and powerfully to make us feel less inhibited, happier and more powerful, whereas it takes time and work to produce serotonin and its effects are much subtler.

 

On the negative side, however, alcohol is short acting, can make us emotionally dysregulated, impairs judgment and often leaves us feeling sick, empty and unmotivated when it wears off. Most importantly, when the alcoholic wants to stop drinking, something interesting happens. The receptor recognizes that it is no longer receiving the alcohol, but it is no longer interested in, or receptive to, the serotonin. It only wants alcohol, and so sends a message to the rest of the brain that it is not getting what it wants. With no alcohol and no serotonin completing the “happiness circuit”, we can become restless, depressed and anxious. Not only is the serotonin circuit compromised, but other neurotransmitters (notably dopamine) start adjusting their levels to compensate. The discomfort that all of this produces is often what pushes the alcoholic to “fall off the wagon” and begin drinking again.

 

Treatment for alcohol addiction and maintenance of sobriety requires a multi-faceted approach. Recovery starts with intention and then requires medical, psychological and lifestyle interventions. Medication, counseling, holistic practices, residential and/or day treatment programs can all be components of a successful recovery program. The support of others, including family, friends and recovery groups, such as 12 Step programs, is invaluable. It is important to note that the addiction never goes away, but we have the ability to not be actively engaged in our addictive behaviours. Acting out is often triggered by stress, and so we must be vigilant and establish lifestyle and emotional management practices that help us to remain stable.

Attachment and Discipline

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Attachment is an intimate, powerful and enduring bond between two individuals. It is rooted in the mother-child relationship and has huge implications for our functioning in virtually every area of development.

 

Secure, or healthy, attachment is the foundation for future happiness, good mental health, respectful/caring relationships and overall wellbeing. Those with secure attachment are more likely to stay in school, find and maintain employment, not abuse substances, have solid friendships and form deep, lasting intimate relationships.

 

The importance of healthy attachment is without dispute, but how does the theory and practice of child discipline fit with this concept? It has been suggested by some that behavioural interventions are inconsistent with, and might even negatively impact, the development of secure attachment. This belief is likely based upon a mistaken belief that such techniques are punitive, controlling and emotionally distressing for the child and must, therefore, hurt the attachment relationship.

 

If, however, we view the goal of raising children to be that they become ethical, respectful individuals, capable of taking responsibility for their own behaviour, then attachment and discipline become essential partners in this process. Children must receive clear messages about their behaviour in order to learn to manage their own actions and, done properly, such guidance does not cause emotional distress. In fact, knowing that his/her attachment figures care enough to set and maintain limits actually builds trust and reduces anxiety. Furthermore, if our children act in inappropriate ways outside the home, they will elicit negative reactions from adults and rejection from peers. This, in turn, can lead to anxiety, depression and low self-esteem.

 

Managing a child’s behaviour is a small, but vitally important, part of the parent-child relationship. Demonstration of affection, doing activities together, talking and sharing tasks are just a few of the myriad other things that we do with our children. If, at the end of the day, we have treated them with love and respect, expected the same from them, corrected inappropriate behaviour, validated positive behaviour and created a safe, secure home environment, then we have paved the way for them to become healthy, responsible, well functioning adults.

 

That is our primary task, as parents.

The Sickness Within – Lateral Violence Within First Nations Communities

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Lateral violence occurs when a group of individuals are mistreated and are unable to have influence, or feel powerless, to deal with those perpetrating the abuse. As a result, they begin to mistreat others in their own group. Lateral violence occurs in many organizations, professions and groups, but has become epidemic within First Nations communities. Although it is unpleasant and distressing when one person treats another in an abusive, disrespectful, hurtful and/or critical manner, it can be catastrophically damaging to the health of these communities when this behaviour becomes widespread.

 

Our limbic (emotional) brains are designed to ensure that we survive and so, when we are threatened, it produces fight or flight responses. These responses pull blood away from some of our vital organs and send it to our eyes, ears and other parts of our body that help us to deal with the danger. As well, our immune system (that protects us from disease) is shut down and our brains produce a flood of chemicals that make us alert and able to respond quickly and powerfully. When the threat disappears or is dealt with, our system settles back down to its normal state. It becomes a problem when we are in fight or flight too often and/or for a long time. It is like running your car on race car fuel………too much, too often will burn out the engine.

 

When a person is stressed and is in fight or flight, they can learn to calm themselves and they can also be calmed by family, friends and others who are not in fight or flight. When whole families, or even whole communities, are in fight or flight, there is a danger that we won’t be able to calm ourselves, those around us aren’t healthy enough to help us and we are continuing to be pushed into fight or flight by the lateral violence around us. Our relationships suffer, we become anxious and depressed, we may isolate ourselves and we get sick more often.

 

But there can be another, more serious , result. Families, communities and even countries are like the human body, and all the different people, organizations and services are like the organs and systems of the body. When these entire social groups are consumed by lateral violence, they become sick. People hurt and abuse one another, substance abuse increases, suicide becomes an increasing risk and fear and anger become the dominant emotions. Sadly, it is the children who will suffer the most. The human brain is like an absorbent, flexible sponge and is, especially during the first 26 years of life, forming critical attitudes, values, emotional responses, attachments and social behaviours. Any damage, such as occurs with this toxicity in the community, is extremely hard to repair and leads to unhappiness and difficulties with school, friendships and even physical health. Without intensive help, these problems persist into adulthood and the cycle of lateral violence and abuse continues into the next generation.

 

We have a responsibility to take control of our community’s wellness, and this starts by taking control of our own behaviour. It is a choice to engage in lateral violence, to abuse substances and to be negative and destructive. Until each person takes a stand against this destructive force, it will persist and our communities, and most particularly our children will become sicker and sicker.

 

  • Refuse to participate in gossip
  • Do not allow others to engage in put downs and criticism
  • Don’t keep secrets
  • Stop complaining about what’s wrong……do something to make it better
  • Refuse to associate with, or be a part of, groups that engage in destructive behaviour
  • Take responsibility……..the only behaviour you have control of is your own
  • Treat everyone with respect……it’s contagious

ADHD AND ADDICTION IN OUR CHILDREN – A Cautionary Lesson for Parents

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All parents are aware of the risks associated with children using drugs and alcohol. We know that these substances are potentially damaging to human health and that they are all, to a greater or lesser degree, addictive. We also understand that some people are physiologically and psychologically more vulnerable to becoming addicted and that family (genetic) history is highly predictive of addiction in our children. Also, and of growing concern, is the prevalence of other addiction risks, including internet/electronic based activities such as texting, social media, gaming and pornography. Other addictions include gambling, shopping and sex/love/relationship addictions. It is very clear that there have never before been so many powerful, potentially addictive substances and activities available, and readily accessible, to our children.

 

Without going into a detailed discussion of addiction, it should be understood that it is a pattern of behaviour which occurs in an obsessive/compulsive fashion and that has a negative impact on important areas of our lives such as relationship, school, work, mental and/or physical health. Current theory is that it is a medical/physiological condition with significant behavioural components, and that different addictions may involve specific neurochemical systems within the brain. Several addictive substances and a number of behavioural addictions are primarily involved with the dopamine system, which, as we know, is associated with reward and with high-risk, extreme activities.

 

But we know, as well, that ADHD is a disorder whose neurological function is also rooted in the dopamine system, and therein lies a formidable danger for those having this disorder. It is well known that the likelihood of those with ADHD engaging in addictive, high risk behaviours is significantly higher than for those not having ADHD. Young people with ADHD may be marginalized socially, struggling academically and/or have a variety of psycho-social challenges that make these addictive behaviours and activities extremely attractive. There is also a restlessness and sense of not fitting or being like others that is reported by most people with ADHD and, again, this increases the perceived value of “medicating” with substances and activities that provide a surge of dopamine. It is interesting to note that the rate of substance abuse for individuals with ADHD who are taking prescribed stimulants is virtually the same as for the non-ADHD population.

 

What is to be done? ADHD children (like all children) need to develop the ability to self-manage and take responsibility for their own behaviour. This is accomplished through consistent, effective behaviour management that promotes self-discipline and a sense of agency. In combination with healthy attachment, this produces robust self-esteem, the ability to regulate emotions and to create/maintain meaningful connected relationships with others. Children (and adults) with ADHD have poor executive function, which means that they will require considerable guidance in organizing themselves and in making decisions. This is critical during childhood and adolescence, and parents should expect to have to monitor and manage potentially risky behaviours and to set reasonable limits around computer and phone use. Remember that children with ADHD are characteristically emotionally and socially 1/3 less mature than their peers, so a 15 year old may be require supervision more like a 10 year old would need.

 

Higher level, value based decision-making does not develop on its own. It must be taught and parents must be prepared to take a more directive role, as required. This is the basis for the development of safe, moral ethical behaviours. The ADHD child is vulnerable, but absolutely capable of achieving this level of functioning if parents commit to providing necessary information, building healthy attachment and implementing the appropriate behavioural limits that they require.