July 18, 2018
“It’s not easy to be human. For anyone. And some of us find being human excruciatingly hard. Your battle with addiction may look nothing like mine. But at our core we are the same: struggling to find our way, looking to stay safe, wanting to be connected, seeking pleasure, and hoping to feel loved.”
The above paragraph from The Addiction Spectrum: A Compassionate Holistic Approach to Recovery, by Paul Thomas, MD, and Jennifer Margulis, PhD, beautifully sums up the source of addiction: Being human is hard. Period. Which is why I agree with Thomas when he says that mainstream ideas about addiction, both causes and treatments, are outdated and in need of an overhaul, an overhaul that this book neatly provides.
Anyone can develop debilitating addictions
Addiction, Thomas says, is not a binary either/or condition. Instead, like so many other chronic conditions, it occurs on a spectrum, requiring an individualized approach to treatment that considers the whole person. There are those with minor addictions, who might find it hard to get through the day without a cup or two of coffee or punishing themselves at the gym for a couple of hours, but while their addictions may be annoying, they don’t threaten to take over their lives. Then there are those whose brains and bodies are so addled by substance abuse that they exist for nothing more than the next opportunity to get high. While many people living at the “mild” end of the spectrum look down upon those who inhabit the “severe” end of the spectrum—often judging them as lacking in moral fiber or willpower—the fact is that it can be terrifyingly easy to move along the addiction spectrum from the mild to the severe end. And it can happen terrifyingly rapidly. Thomas emphasizes that it’s important for us all to know that genetic predispositions combined with exposure (especially early exposure) to addictive substances and stress can move anyone in the direction of severe addiction; “addictive personality” not required.
Sadly, for a growing number of stressed people with genetic predispositions to addiction, exposure comes from the very people who are supposed to be helping them: clueless or careless doctors who hand out prescriptions for powerful drugs with alarming ease. Though Thomas is a physician himself, he has sharp words for those who not only fail to address the roots of their patients’ problems but compound those problems as well by prescribing highly addictive drugs without even asking basic questions to determine whether their patients are at high risk of developing an addiction.
One of the reasons I’m so glad that Thomas and Margulis wrote this book is because TMR readers are often people with developmental disabilities or the parents of people with developmental disabilities who can easily have the right combination of genetic predispositions, toxic exposures, and stress to make moderate-to-severe addiction a strong likelihood. Many people in the special-needs community have understandably developed addictive behaviors in order to help them cope, and this book can help anyone with any addiction move back to a safer place along the addiction spectrum. In addition, parents are often pressured to put their children on prescription medications, including powerful stimulants like Ritalin and Adderall, and it’s important to understand the real risks inherent in doing so. Thomas’s down-to-earth, practical discussion of addiction and recovery should make this book invaluable to the TMR community, and I would love to see it on everyone’s bookshelf.
People living at the extreme end of the addiction spectrum frequently have no understanding of the spectrum, seeing their situation in black-and-white terms. They don’t know how they got where they are and cannot see any possible way to move back to the mild end of the spectrum because they don’t even know there is a mild end. Those people and their loved ones may be the people who get the most out of The Addiction Spectrum. Thomas and his wife, Maiya, provide powerful examples of how the seemingly impossible can be accomplished: Maiya became an opioid addict after being given prescription painkillers as a teenager, and Thomas became a heavy drinker starting in college. Both have been sober for fifteen years, and Thomas now runs a rehabilitation center in Portland, Oregon. So, as a doctor who treats addiction and a recovering addict himself, Thomas knows his stuff.
My history with addiction and the Twelve Steps
I was particularly interested in this book because of my own history with addiction. I come from a family where alcohol abuse has been, and still is, rampant. Two of my older brothers struggled with even more dangerous addictions, with one of them reaching its peak in a near-death experience brought on by a heroin overdose. He later kicked the heroin and became an addiction counselor who sponsored a conference on alternative approaches to addiction treatment in Washington, DC, that I attended. While I have been lucky enough to be situated near the “mild” end of the spectrum for much of my life, I did suffer from highly compulsive eating behavior in my teens and twenties that sent me to Overeaters Anonymous where I became very familiar with the 12-step approach to ending addictive behavior. This approach is based on the work of Bill Wilson (known within the program as “Bill W”) and the organization he founded, Alcoholics Anonymous (also known as “AA”). The cornerstone of the AA approach is the Twelve Steps, a series of actions that when taken increase the likelihood of being able to live without addictive substance abuse. The Anonymous groups have been very successful for over 80 years in helping many, many people recover from their addictions, but I believe they are hampered in their efforts by some significant limitations and outdated thinking.
The importance of suspending self-judgment and all-or-nothing thinking
I was happy to see that Thomas exhibits a deep understanding of both the advantages and limitations of the 12-step approach to addiction. One of the very best things about 12-step programs is that addiction is seen as a “disease” and not a character failing. This means that people experiencing severe addiction can, possibly for the first time in their lives, suspend judgment about how and why they got where they are. And that suspension of judgment is crucial in the ability to recover: You cannot recover if you are screaming at yourself. That’s why you will often hear at Anonymous meetings that depression, considered the most dangerous threat to abstinence, is “anger turned inward.” Societally, we’re taught that motivation comes from self-abuse, but all it really causes is misery and rebellion.
Another of the wonderful things about 12-step programs is the idea that “progress, not perfection” should replace black-and-white thinking. Unfortunately, I have found that this transformative mindset is often undercut by an all-or-nothing approach to behavior: In AA you are either “using” or you are “abstinent.” There is nothing in between. Abstinence is “good”; using is “bad.” This all-or-nothing approach can be a problem for many struggling with addiction or addictive behavior, particularly those suffering from heavy opioid addictions who must taper off slowly in order to recover safely and successfully or more subtle behavioral addictions to things like food and exercise, which cannot be stopped altogether.
Thomas clearly understands the problem inherent in this thinking. One of the most important and illustrative paragraphs in the whole book comes in the section titled “Relapse is Expected but Not Required” in the chapter on opioid addiction:
Addiction is a chronic, relapsing illness, and it’s important for you to think about what that means. A patient whose eczema is under control thanks to diet, exercise, avoidance of toxins, and medication might have an unexpected flare-up—because of either something she ate, something she touched, or even stress. We don’t think of drug relapse that way, usually, because we think addicts “should” have the willpower to keep addiction under control. But if you think of a relapse as a flare-up, something that happened and that you can get on top of—not something that shows that you are a moral failure or a bad person—you will have an easier time getting sober again.
Remember that crucial suspension of self-judgment I mentioned? Clearly Thomas understands this well when it comes to connection and support. If you relapse and use again, that’s exactly when you need to come back and talk to him, or a counselor, or a 12-step sponsor. Most people who don’t suffer from addiction don’t understand this; often family members and other loved ones withdraw their support just when the addict needs that support the most. It’s understandable, of course. Loved ones have often been through hell due to the addict’s behavior. If the behavior reappears, they see their worst fears being realized. The addict sees this withdrawal as confirmation of their own moral failings—feeling they deserve to be abandoned—and this self-judgment can cause what could have been a minor flare-up to spin so far out of control that it confirms AA’s declaration that addiction is a progressive illness that gets worse even when you’re not using. But that becomes a self-fulfilling prophecy, and without the judgments and the internal screaming, it simply does not have to be the case. A flare-up, while not desirable, can be just a bump on the road to the “mild” end of the spectrum.
Anyone can get better at any time
Another core tenet (and huge limitation) of the AA approach is that you have to “hit bottom” and really, really want to recover in order to make progress. Granted, the bottom is considered to be different for everyone, but “bottom” still implies that until one believes that there is nowhere to go but up, one cannot be motivated enough to change addiction behavior. This is one area where Thomas’s spectrum approach becomes tremendously important. There is no need to wait to till some sort of bottom is reached in order to make positive changes. Thomas makes it clear that if we treat addiction as the spectrum that it is, we can take steps to move toward the milder end of the spectrum at any time simply because we want our lives to improve. Similarly, even when someone has no wish to stop using, treatment that emphasizes Thomas’s suggestions can often result in a huge shift toward the milder end of the spectrum. Again, Thomas’s wife Maiya provides a powerful example: The Thomas family staged an intervention, and Maiya was given no choice about seeking treatment. She then spent 90 days inside a treatment facility that was the jump-start she needed to find the motivation to stop using opioids.
How to shift to the mild end of the addiction spectrum
So, what does Thomas recommend people do to move themselves along the spectrum? It probably won’t shock any of our readers that one of the primary interventions for any type of addiction is to eat real, whole, nutrient-dense foods, as close to organic as possible. In fact, Thomas considers this so important it shows up in some form or another in every chapter. This is one area where TMR readers may have a head start. Other important suggestions include establishing better sleep routines, getting regular exercise (anything that gets you moving often enough and long enough to change your brain chemistry), finding effective ways to reduce your stress, and finding ways to connect with other human beings who will support your recovery. The importance of such connection is evidenced by studies that Thomas cites on mice and morphine addiction. The studies showed that when mice, who are social beings, have all the company they could desire they do not choose morphine-laced water over plain water. In fact, even mice who were pre-addicted to morphine by the researchers could forgo morphine-laced water if they had the opportunity for social connection!
Addiction as pain avoidance
Not surprisingly to anyone who has recovered from an addiction, one of the most important subjects in the book is pain. One of the reasons we are in the midst of an addiction crisis in the U.S. is that we Americans tend to avoid pain at all costs. There are a number of problems with this. Removing pain without addressing the root cause is only a temporary solution at best—and one that can actually end up increasing the overall level of pain. In other words, the avoidance of pain can end up being far more painful than just facing the pain in the first place. This can apply to both physical and emotional pain and is often quite literally the case when it comes to addiction to painkillers. When opioids dull pain, the brain creates more receptors to take up the excess opioids, which then increases the body’s receptivity to pain as well as tolerance to the drug, prompting larger and larger doses to get the same pain relief. According to Thomas, one of the problems with opioid addiction recovery is that high-dose users report high pain levels. Giving up the painkillers can seem impossible in such circumstances. It should come as good news to people addicted to prescription painkillers, then, to hear that experience and research have shown that gradually reducing painkiller dosage actually results in a lessening of pain over time as the cells respond to the decreased level of opioids by decreasing the number of pain receptors.
Opioid addicts aren’t the only ones avoiding pain, however. Virtually all addiction is born from an effort to avoid feeling pain. And as Thomas says,
When you try to stop [the addictive behavior], the withdrawal symptoms feel like the pain you’ve been trying to hard to avoid all your life. So you start again. This becomes a self-fulfilling, never-ending cycle that keeps you in bondage, no matter how hard you try to rationalize it or deny your addiction.
This is why one of the most important steps in Thomas’s 13-point plan for addiction recovery is about changing your mindset about pain. Not only is it okay to feel pain, feeling the pain is necessary to extract the information you need to heal. Thomas says, “When you start feeling pain, you know you’re doing something right.” I can verify from my own experience that this is true. Whenever I fully accept my pain and let it move through me, I soon find myself feeling much better. On the other hand, when I avoid the pain with addictive behavior or a substance like alcohol, at best I merely postpone dealing with whatever’s causing the pain, and at worst I can spiral into crisis.
The Twelve Steps as a tool for transformation
Though I don’t agree with everything about the Anonymous programs, I think the Twelve Steps are an incredible tool for healing and transformation. I remember thinking when I was going to meetings that it’s a shame that only people struggling with addiction do the Steps because they are so powerful. Normies had no idea what they were missing. Thomas sees the value of working the Steps for anyone at any point along the addiction spectrum as well. He restates the Steps in secular terms for those who may have trouble with the spiritual aspects of Anonymous program and, rightly, puts a great deal of emphasis on the most important quality needed to make the Steps work: rigorous honesty. As Thomas says, “It is only when you are ready to be honest—with yourself and with others—that you really start to heal.” As AA famously says, “We are as sick as our secrets.”
Often when people buy books, they stop reading before they reach the end. I think this is particularly true of non-fiction, even self-help books like The Addiction Spectrum. I am urging you right now not to do that with this book. Make a point of finishing it. Read every single chapter; each one contains significant nuggets of insight that will help you or your loved one on your recovery journey, even if you don’t have a problem with the particular substance or behavior under discussion. The cannabis chapter, in particular, contains an incredibly balanced discussion of both the important health benefits and the real health risks associated with cannabis use. Historically, the risks have been greatly exaggerated. More recently, the pendulum may have swung to an exaggeration of the benefits to the point where people are not acknowledging that there are real risks to indiscriminate cannabis use, especially to young, developing brains.
I do have a few minor quibbles about the book. Approximately 45 million Americans start a diet each year, spending up to $33 billion on weight loss products. These numbers make it apparent that addictive behavior around food is a huge problem in this country. Despite this, Thomas doesn’t cover the topic of food much at all. Nor does he include any warnings about addictive behavior around exercise or sex when he suggests using them as ways to feel good without “using.” More importantly, I think that his suggestion to use lovemaking as a way to relax before sleep could be problematic for many people with addictions, especially those who have a history of sexual abuse. Childhood sexual abuse can make it extremely difficult for an addict to approach the subject of sex in a relaxed manner. It may also be the area where rigorous honesty is hardest to achieve because of societal shaming. Personally, I used to find that sex right before bed would often make achieving a good night’s sleep more difficult, rather than less. Lastly, I would love to see Thomas incorporate the work of Evelyn Silvers, who developed a method of enabling addicts to use their bodies’ inherent capability to produce non-toxic versions of their drugs of choice. This technique, based on the work of Candace Pert (author of Molecules of Emotion), allows them to safely self-medicate through difficult times.
But as I said, those are minor quibbles, and minor quibbles are certainly to be expected when in the process of overhauling an entrenched method of treatment and introducing a new paradigm.
For the vast majority of people struggling with addictive behaviors—and the loved ones who wish to help move them back toward the mild end of the addiction spectrum—this book will be a welcome godsend.
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