Mar 13

12-Step Programs and Addiction: Myths Busted By David Sack

David Sack, MD, is an addictions specialist with a blog on Psychology Today called “Where Science Meets the Steps.” A couple of his posts as well as a recent article by him in the current print edition of PT are useful toward understanding some common myths regarding both 12-step programs and addictions recovery.

Whereas the 12-step myths in bold letters below are taken verbatim from the PT article, the quotes come from a previous post by Sack.

  1. You Must Believe in God True, Christianity figured into the development of the steps initially. And whereas choosing a “higher power” can still involve “a religious deity or entity…it can also be the power of a group working toward a common goal, nature or some other outside force. If you feel uncomfortable with the spirituality of a particular group, keep searching until you find a closer match.”
  2. You Are Powerless and Not Responsible “Powerlessness occurs because prolonged drug abuse changes the structure and function of the brain, and it takes time in sobriety to repair the damage. Powerlessness does not mean that the addict is inherently flawed, exempt from thinking for themselves or incapable of recovery, or that they can rely on their higher power to fix everything without taking steps to improve their own lives.”
  3. 12-Step=Dependency “In the early stages, people may benefit from frequent attendance, which often diminishes over time as they develop other support systems and become more firmly grounded in their recovery…If recovering addicts find that support in 12-Step meetings, they should continue to go. This type of ongoing participation in a program that improves members’ lives is very different from a destructive drug or alcohol dependency.”
  4. 12-Step Is a Cult “People are free to participate or not, and to take what works for them and leave the rest. There is hope that participants will embrace the wisdom of some of the 12-Step principles but they are also encouraged to think critically and to find their own way.”
  5. Too Many Rules Guiding principles and suggestions may abound, but not rules. The principles  “address specific deficits in learning, memory, empathy and other areas impacted by drug abuse.  Sharing stories, along with routinely scheduled meetings and oft-repeated mantras, for example,    help addicts remember the next right thing to do even when their thinking is still clouded by drugs.”
  6. 12-Step is For the Weak “The opposite of weak, it takes tremendous strength and courage to reach out for help. Some people may be able to recover on their own, but most cannot – and there is no shame in that. People with other chronic diseases do not expect to heal themselves, nor should addicts.”
  7. 12-Step Doesn’t Work The scientific and recovery communities disagree on this point. “Science has long dismissed 12-Step recovery, leaving a dearth of data where 75 years of history should provide much more, and 12-Step recovery has long rejected the need for and validity of scientific inquiry. But the necessary conclusion is not that 12-Step recovery doesn’t work; rather, the research, to date, has been inadequate.”

The following myths about addiction that Sacks believes can undermine recovery are from another PT blog post:

  1. Addicts are bad people who deserve to be punished. Rather, bad things often happen when addiction is involved. “Driven by changes in the brain brought on by prolonged drug use, they lie, cheat and steal to maintain their habit. But good people do bad things, and sick people need treatment – not punishment – to get better.”
  2. Addiction is a choice. “People do not choose to become addicted any more than they choose to have cancer. Genetics makes up about half the risk of addiction; environmental factors such as family life, upbringing and peer influences make up the other half.”
  3. People usually get addicted to one type of substance. Polysubstance abuse is actually now the norm, whether to create a better high or to use one drug to counteract another’s effects or to take advantage of what’s more available at the time. “People who abuse multiple substances are more likely to struggle with mental illness, which when complicated by drug interactions and side effects, makes polysubstance abuse riskier and more difficult to treat than other types of drug abuse.”
  4. People who get addicted to prescription drugs are different from people who get addicted to illegal drugs. Less stigma is attached to licit drugs, but they’re not safer. “When a person takes a prescription medication in a larger dose or more often than intended or for a condition they do not have, it affects the same areas of the brain as illicit drugs and poses the same risk of addiction.”
  5. Treatment should put addicts in their place. Shame is worse than ineffective, but unfortunately is still used in some addiction recovery centers.
Feb 11

Romantic Love: Craziness, Infatuation, and Limerence

Romantic love. Things begin and get more and more exciting—crazy even. Just ask an expert:

One is very crazy when in love.
Sigmund Freud

And another social observer:

Romantic love is mental illness. But it’s a pleasurable one. It’s a drug. It distorts reality, and that’s the point of it. It would be impossible to fall in love with someone that you really saw.
Fran Lebowitz

The late psychologist Dorothy Tennov, in her often-quoted book on love published in 1979, coined this feeling “limerence.” Less clinical terms are also used, of course. On Oprah. com, Valerie Frankel:

Lay terms for limerence: romantic love, crazy love, lovesick, mad love, amour fort. You see a theme in the words crazy, sick, and mad. In this condition, one’s body drugs itself mightily with hormones that create a feeling of joy. The rapture is balanced with the panic and dread that it could end. And it will. Limerence has a shelf life.

Psychiatrist David Sack, The Huffington Post, points out a synonym I hadn’t heard of, “affection deficit disorder,” and elaborates further on the topic of limerence:

Some call limerence infatuation, lovesickness, or romantic love, while others relate it to love addiction. Some have humorously called it affection deficit disorder. Albert Wakin, an expert on limerence and a professor of psychology at Sacred Heart University, defines limerence as a combination of obsessive-compulsive disorder and addiction, a state of ‘compulsory longing for another person.’ He estimates that five percent of the population struggles with limerence…

“Struggles” with limerence. As when it hurts not in a good way and goes on seemingly forever instead of the 18 months to two or three years often quoted by the experts. If it does last a really long time, there’s probably something more pathological going on. This kind of fixation may lead, for example, to stalking behavior.

Some people, on the other hand, don’t ever enter the limerent state.

And some people studying this topic don’t see infatuation and limerence as the same thing, with the former being positive and bearable, the latter a more troublesome condition.

So, what causes limerence? Read on if you like details about brain-related stuff. Victoria Fletcher, Daily Mail, explains in clear language:

Studies have shown brain chemical dopamine is at higher levels in those in love. Dopamine is key to our experiences of pleasure and pain, linked to desire, addiction, euphoria, and a surge may cause such acute feelings of reward that it makes love hard to give up.

Tests show that taking opioid drugs such as cocaine have a similar effect on dopamine as love.

A side effect of rising dopamine levels is a reduction in another chemical, serotonin, a key hormone in our moods and appetite.

Serotonin levels may fall in a similar way to those seen in people with obsessive-compulsive disorder, explaining why love can make us feel anxious and jittery.

The love chemical we are most familiar with is adrenaline. This hormone is why our heart races, palms sweat and mouth goes dry when we see the person we like.

The same hormone is also released when we are frightened. This means that two people only vaguely attracted to one another can fall madly in love if they go through an exciting or scary experience together. It may also explain the lure of forbidden love.

Despite the “craziness” of it all, and despite efforts on the part of some limerence researchers, the upcoming DSM-5 does not appear to be including it as a diagnostic category. More studies are needed.

You’d be crazy not to sign up…or to sign up?