Why is it so hard to stay quit?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

“Quitting is easy. I’ve done it a thousand times.”

This old joke has been applied to drinking, smoking, and gambling, and has been attributed to Mark Twain, W.C. Fields, and others. It still rings true. While many people try to quit, relatively few stay quit. For most people who use substances, that use has become a habit, and under times of stress, good or bad stress, humans tend to revert to their usual default behaviors. For recovery skills to work, they need to be over practiced until they become automatic.

Three factors are involved in a return to using substances or to behaviors like gambling. We often call this return to old behavior relapse. Triggers are events or feelings which place the idea of using back into your consciousness. Urges are strong desires or impulses. Cravings are those intense feelings driving you towards a return to active use.

Relapses begin with thoughts rather than actions.

You may have heard the saying, “relapse begins in the mind,” which is sometimes referred to as stinking thinking. There has been a tendency recently to blame addiction or alcoholism on the substance. Certain drugs may have more severe withdrawal symptoms than others, but addiction is more complicated than merely getting the drug out of the body. Many people go through detox and then go without the drug for a long enough time. That the drug is no longer in their system, yet they still relapse. Without long-term treatment, most people, who go through detox, eventually returned to using the drug of choice. Sometimes this relapse happens after months or even years of being clean and sober.

Cutting down doesn’t work.

Many people with a drug or alcohol problem try the approach of cutting down. Instead of finishing off a six-pack of beer each night, they try to limit themselves to two or three beers. Trying to control your use rarely works over an extended period. If your drinking or drug use has reached the point where you need to cut down, you’re far down the path to addiction.

Using alcohol and drugs instrumentally, to celebrate, to cope with emotions, is a dangerous path. Very few people stay “cut down” for very long. If you’re drinking or using, even a little, you’re at high risk to end up with a substance use disorder again.

Trying to control your addiction puts the drug in control of you.

Normal people don’t try to control their use of drugs and alcohol. If you are doing something enough that you need to cut down, that activity has become a problem. Loss of control is one of the characteristics of the disease of addiction.

Addicting drugs and behaviors have three characteristics which bring you back.

Over time, as you use substances, you build tolerance, meaning it takes more and more of the substance to produce the same effect, or if you use the same amount you get less and less effects. Where you used to get a buzz on after one or two beers now, you need six.

When an addicting substance leaves the body, you will develop withdrawal symptoms. Even relatively mild substances such as caffeine have withdrawal effects. Go a couple of days without your coffee, and you will probably have headaches and be irritable. Withdrawal symptoms can be either physical or psychological, such as irritability or depression.

When you are deprived of your addicting substance, you’re likely to experience cravings. Giving in to those cravings reinforces addiction. Every time you give in to the cravings, the addiction grows stronger. The challenge in quitting is to go without the substance long enough for the cravings to subside.

If you’ve developed a problem with a substance, consider seeking help. Without help quitting and staying quit is a challenging task.

Staying connected with David Joel Miller

Four David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon,

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking, and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter.

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Psychopharmacology – counselorssoapbox video

Psychopharmacology – counselorssoapbox video

Why do drug effects differ? Tolerance, withdrawal, and cravings. Physical and psychological characteristics of the user all play a role in drug effects.

 

What is an addiction?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Hands with pills

Addiction.
Photo courtesy of Pixabay

How many addictions are there?

More and more things seem to be getting labeled as addictions.  This mushrooming of addictions has resulted in a lot of skepticism about whether all these items are real addictions or just excuses by people who do too much of one thing or another.

The mental health professions don’t typically use the word addiction. We use other terms to help explain why what is commonly called an addiction may look so different in different people.

Let’s explore this problem by starting with the best known of all addictions, drug addiction and then see what other things might qualify as addictions.

Drug addiction.

Most drugs, legal and illegal, result in two specific reactions in the body, tolerance, and withdrawal. Tolerance means that over time your body builds up a resistance to the drug so that it takes more and more of the same drug to get the same effect.

Physically addicting drugs all result in tolerance in the body.

Withdrawal is the phenomenon of symptoms that occur when the level of the drug in the bloodstream begins to drop. As many an alcoholic knows if you can keep the level of alcohol in the bloodstream up, you can hold off the hangover for a while. Eventually, you fall asleep or more precisely pass out, and then the blood alcohol level drops.

The drop in the level of drug in the bloodstream, not the absolute level is what is causing the withdrawal symptoms, sometimes also referred to as “abstinence syndrome.”

When someone has been abusing drugs, including alcohol, we take them to a detox. They go through a lot of symptoms, some very unpleasant, as the drugs leave their system. So after 3 days or so, defiantly in a week, almost all drugs (except marijuana) are out of the system.

The carvings problem.

No drug (alcohol) in the system, the hangover or other withdrawal symptoms go away. In the case of heroin, the shakes, diarrhea, vomiting, goosebumps, and all the other classic symptoms of opiate withdrawal end and the person, now with no detectable drugs in their system are discharged to go home.

The majority of all people who go through detox, somewhere over 90%, will relapse or use again in a month or so after the detox.

If the drugs are all out of their system why are they still exhibiting addictive behaviors?

The problem with addiction is not the chemical dependency in the body, as awful as that can be. The real problem of addiction is that it is a problem of the mind.

We might call this manifestation of addiction a psychological dependency on the drug to differentiate it from a physical addiction. Even when no drugs are in the body the cravings remain in the brain.

Behavioral Addictions.

So can people really be addicted to things like shopping, sex or compulsive spending?

My belief is that these kinds of activities can also be addicting but are not automatically addiction.

Each activity produces thoughts, those thoughts move through the brain chemically. Change your thinking and your brain chemistry changes. Some experiences, falling in love, having sex, can produce chemical changes in the brain that can be like an addiction.

One key criterion for addiction is the loss of control, if you lose control of an activity you are approaching addiction land.

Continued use of a substance or continued repetition of a behavior despite negative consequences, loss of control over a behavior fit this pattern.

Hypothetical example.

A client says she is “addicted to poodles.” She has poodle skirts, poodle statues, and pictures all over her house. Her husband gripes about all these poodle things but they are still together after 25 years. She says she is “addicted to poodles.” I think she has an unusually large interest, even an obsession with poodles, but so far it does not sound like an addiction.

Let’s say she also has 25 live poodles in the one-room apartment and that she has spent all of their money on poodle stuff this month leaving them with no money for rent and food. Now has her poodle addiction crossed the line?

So while excessive involvement in many things might possibly reach the level of being an addiction the more strongly rewarding things like drugs, alcohol, sex or risk-taking (gambling) produce such high levels of chemicals in the brain that many people might become “Addicted” to these behaviors. Most people are not likely to develop an addiction to poodles. The internet on the other hand –

Let’s leave that for now.

So in many ways, I see addiction, to drugs or other things, as a special case of OCD. The person can’t stop thinking about the object of their addiction and with chemicals or behaviors like gambling once they start they lose control over the substance or the activity.

Most recently we are recognizing that it is possible to have a problem with a chemical or behavior way short of developing an addiction. We might call this a “Use Disorder” or with behaviors we might think of it as an impulse control problem.

However you see this, loss of control over a chemical or an activity can cause someone a lot of life problems and needs treatment.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Which alcoholic beverage causes the most hangovers, DUI’s and damage to the body?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

Standard drinks and why they matter.

There are more urban myths and legends around alcoholic beverages than you would find in most children’s storybooks.

People believe that one particular alcoholic beverage is safer or less likely to get you drunk than another. Does drinking shots get you drunk faster? Is wine safer than beer? Can you avoid becoming an alcoholic by sticking to beer and avoiding the hard stuff? Let’s look at the facts behind these beliefs.

All alcoholic beverages share one most significant ingredient – ethanol. Alcohol is produced by the action of yeast fermenting something. Fermenting grains and berries produces ethyl alcohol, which is the only alcohol that can be drunk by humans without fatal results. Wood can be fermented and produces methyl alcohol, but if it is drunk it can be fatal, producing blindness and brain damage before death.

All alcoholic beverages contain ethyl alcohol. When it comes to intoxication – alcohol is alcohol. What varies is the amount of alcohol and the various additives and flavorings. Make no mistake. The more ethyl alcohol you consume the drunker you will get.

To compare one alcoholic beverage with another we have created the concept of a “standard drink.” Correctly served, a standard drink of beer, wine or a shot or hard liquor all contains precisely the same amount of alcohol.

Beer.

A standard drink of beer is a twelve-ounce bottle.  One small can of beer contains one standard drink. People mislead themselves into thinking that drinking beer is safer because it requires drinking more volume than other drinks to get the same blood alcohol level.

More than once a client has said: “I only had a couple of beers but I got a DUI anyway.” It makes a lot of difference if the beers were 12 ounces or 40 ounces. One beer should produce a blood alcohol level of about .02. Two 40 ounce beers are equal to almost 7 of the little ones and will produce a blood alcohol level of around 0.14.  That is past the point of legally drunk in most any place I know of.

It is also worth noting that in the United States of America more than half of all the alcohol (pure ethyl alcohol) consumed comes from beer. Lite Beers may be as bad or even worse.

Also for the record, your liver may develop tolerance to alcohol but the liver only has one speed. No matter how high the blood alcohol level goes the liver can only detoxify one standard drink of ethyl alcohol an hour and the liver only starts to work once the alcohol is digested and absorbed into the bloodstream. This explains why someone can drink a couple of 40-ounce beers, feel fine and then suddenly feel drunk an hour to an hour and a half later after the alcohol gets absorbed into the bloodstream.

Malt liquor will get the drinker even higher blood alcohol numbers, up to half again the numbers for beer.

Wine.

A standard drink of wine is one – five-ounce glass of 12 % wine. This number will vary from text to text. Some places measure alcohol by volume and other countries measure by weight. So don’t be surprised if you read elsewhere that a standard drink is 4 ounces of wine.

If you like “fortified wines” as in sherry or port the size of the glass needs to be smaller. A standard drink of port is a 3.5-ounce glass.

It does not count if you open a bottle of wine, pour one glass and then continue to refill the glass all evening. If you finish off the whole bottle of wine, regardless of the number of glasses you use, you will have consumed 5 standard drinks. Five standard drinks on one occasion for a man or four standard drinks for a woman is binge drinking and does a lot more damage to your body. This is an even bigger problem if you are a binge drinking senior citizen.

Shots – Hard Liquor.

A standard drink of hard liquor is one and one-half ounces of 40% alcohol. Since proof numbers are exactly double percentages that would mean a standard drink of 86 proof liquor should be just shy of 1 ½ oz.

So a person drinking 3 ounces of hard liquor in a small glass gets two standard drinks.

Question?

A beer drinker consumes a forty-ounce bottle of beer; his buddy drinks only one glass with three ounces of 86 proof tequila, who is drunker?

Easy – the beer drinker consumed like three and a half standard drinks, the tequila drinker only consumed two standard drinks, the beer drinker will be way more intoxicated come an hour later when the drink is absorbed into the bloodstream.

See how easy it is to fool yourselves saying you had only one drink when in fact there was a whole lot more alcohol in that one drink than you thought?

In this discussion, we have left out the effects of “tolerance” and “withdrawal” which complicate the math but not the legally drunk part. We also have not talked about drinking something stronger like “151” or “191” and how much closer that could take you to the .60 blood alcohol level where you black out, organs stop working and you get pronounced legally dead.

Also, you need to know that if every time you drink, you end up drunk, that has less to do with the kind of drink you consumed and more to do with your having counteracted a disease called alcoholism.

So the results of this exercise tell us, it really doesn’t matter if you drink beer, wine or a hard liquor, what matters is how much ethyl alcohol is in that drink and what happens to you when you put ethyl alcohol in your bloodstream.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.