I raised my kids in the '80s and '90s. Like many other parents, I was concerned about ways to help them stay out of trouble with drugs and alcohol. During the first presidential term of her husband, Ronald, Nancy Reagan announced her "Just Say No" campaign, an approach that was championed in the public schools by a program called DARE (Drug Abuse Resistance Education). I was encouraged that the problem was getting such aggressive and widespread attention. But a little less than two decades after Nancy Reagan rolled out "Just Say No," the news was bleak. On February 15, 2001, Time Magazine published the bad news:
And did you know that the federal government spent over $19 billion on the "war on drugs" in 2003, with more than another $20 billion spent on the state level? Chances are, though, if you are reading this, you don't need statistics to convince you that drug and alcohol prevention efforts have not been ineffective.
Here's a news flash: "Just Say No" is not an effective anti-drug message. And concerning DARE, "The findings were grim: 20-year-olds who'd had DARE classes were no less likely to have smoked marijuana or cigarettes, drunk alcohol, used "illicit" drugs like cocaine or heroin, or caved in to peer pressure than kids who'd never been exposed to DARE," referring to study published in the August 1999 volume of The Journal of Consulting and Clinical Psychology.
This is a book for people who did not say no, and the family members and friends who love them. And there is good news contained within for all. If you are a family member or friend, you will find principles that will enable you to experience health and fullness in the midst of your painful times of crisis. You will also learn to understand the unhealthy ways in which you may be reacting to the dependency of your loved one. And anyone who is concerned about healthy families will discover relationship concepts that will be instrumental in preventing harmful dependencies in loved ones.
You see, chemical dependency does not occur in a vacuum. It is a relational issue. The quality of relationships between the chemically dependent person and other persons in families, churches, at work, and in society is profoundly damaged. The odds are great that, if ignored, generations of loved ones will feel the crippling effects of someone's harmful dependency.
For an addict, living with an active addiction is like living on a tightrope. And living with—or even loving—that person is like looking up and watching them as they try to keep up the balancing act. It's a rather daunting experience because they aren't a tightrope walker, they are just your loved one. Plus, they are under the influence, which makes them even worse at tightrope walking. In addition to feeling like you need to watch the tightrope act continuously, at times it's actually as if you can't help yourself. All kinds of other things demand and deserve your attention as well—other family members, jobs, hobbies, church, etc. And yet even while you are trying to attend to all the other life concerns around you, you're always thinking, wondering, worrying about the person on the tightrope. So the person's problems and the consequences invade and permeate every area of your life.
And then they slip and fall, or they almost fall, or they look like they're going to fall. That's the latest crisis, phone call, outburst, the latest broken promise. But somehow they always manage to hook the rope with a fingernail and drag themselves back up to continue the "show." Or, because those who love them don't want them to plunge to their deaths, they push them back up by giving them help that just keeps them living on the tightrope, where everyone wishes they weren't living in the first place. And so the cycle goes on and on.
Think about it. How often have you tried, with the best of intentions, to help yourself or your loved one through a problem or crisis, only to discover that the help is not helpful, or has even contributed to the problem. And one day you realize that you have been supporting and helping to prolong on the outside the very thing you do not support on the inside.
But it doesn't have to be that way. Things can change.
Individuals and families become dysfunctional by accident. But they get well on purpose, and this book will help you begin to do exactly that. Part I will do this by exposing the nature and process of dependency, codependency, and shame. Part II explains how to help those who are unhappy with the effects of their own or someone else's problem with mood-altering substances.
Be encouraged. Help is on the way.
PINNING DOWN THE PROBLEM
Have you ever dropped a thermometer while trying to see if you or someone else had a fever? I remember one time as a young boy when my mom decided to take my temperature. Usually it was to prove that, contrary to my urgent pleas, I really was fit to go to school that day. It was a September to May ritual at my house. On this particular occasion, she was right in her assessment, which called for desperate measures on my part. So I removed the thermometer from my mouth and attempted in every way I knew how to make it register enough of a fever to play hooky that day.
I was looking in the mirror practicing my "sick look." At one point I was holding the thermometer in my hands and trying to create sufficient friction to register enough degrees to provide the excuse I needed. Then suddenly it slipped out of my grasp and shattered. As I tried frantically to gather up the shards of glass so I could move them to the bed (where I was supposed to be anyway), I noticed a little drop of mercury pulsating on the dresser. I was fascinated. I became caught up in trying to pin that drop down under my finger. Unfortunately for me, I was so preoccupied with this that I didn't notice my mom watching me from the doorway. Unlike the mercury which had continued to elude me by scooting off to the side, my illusion and "scooting" was over, and I was on my way to school.
Nevertheless, from that day on I loved playing with mercury, and through my elementary years there would be many broken thermometers to prove it. Imagine how delighted I was still later in high school physics when we were actually allotted mercury to work with. I even managed to do some of the assigned experiments.
This is fine and good for childhood curiosity and classroom experiments. Unfortunately, oftentimes that's what it's like when you are dealing with someone's addiction. I can't tell you how many frustrated family members have used that very phrase, "like trying to put my finger on mercury," as they attempted to describe what it has been like to first understand the addiction of a loved one and then get them the help that was needed.
It is essential to have a "language" to use when trying to understand and then seek help for a problem. For instance, it would be like noticing a change in how you felt but not knowing why. What you did know is that you felt generally fatigued. You began to nap more, or take walks, or eat more fruit. But nothing really seemed to help. Then you went to the doctor and were diagnosed as having Type 2 diabetes. Once you had the right "language" to describe the problem, you discovered that there were many things you could do, many resources available that would actually help.
I am not suggesting that family members become expert diagnosticians when it comes to identifying problems in one another. In fact, I have seen countless cases where, in their need to find the "perfect" diagnosis, they wait too long to take steps to begin a helpful process. In other words, it has been easier to think about an addiction than it has been to do something about it. I am suggesting, however, that it is important to at least have enough of a language to recognize addiction as addiction so the resources that are available can be utilized in order to embark upon a truly helpful course of action.
That is the purpose of this final chapter. I will begin first by speaking in general terms about addiction. These are words, phrases, and descriptions that will help you to know (diagnose) whether what you are looking at in a loved one is really addiction or not.
As I have continued in the field of addiction and recovery through the years, I have noticed trends emerge and then dissolve with regard to the popularity of certain drugs and their accompanying addictions. And so I will conclude with some more specific tell-tale signs to watch for when these particular drugs are involved.
Tolerance describes how much of a substance is needed to quench the increasing desires a user has for a drug or alcohol. There is physical tolerance as well as mood tolerance. Physical tolerance with alcohol occurs because the liver becomes more efficient at metabolizing it. Simply put, alcohol is sugar and toxins (poison). Hence the word "intoxicated." When a person is intoxicated (drunk), it just means that they have put more poison in their body and have done it more quickly than their liver can process. In effect, they are poisoned. But as time goes on, the liver becomes more efficient at the task, and so more poison must be added to get the same effect.
When I say mood tolerance, I just mean that it takes a bigger alteration of the mood to get the same satisfaction as before. For example, after a while, it's no fun to bungee jump off a bridge anymore. Now the person must jump off a hot-~air balloon. This is why someone can lose their family over gambling. There is no substance involved, but there is a mood-altering phenomenon which, for an addict, must be increased to satisfy their desire.
Withdrawal describes the occurrence and seriousness of the symptoms experienced by the user when they are not using their addictive substance. In the case of alcohol withdrawal, symptoms range from mild (shakiness, anxiety, rapid mood swings) to medium (nausea and vomiting, headaches, sweating, insomnia) to heavy (convulsions, hallucinations, seizures). A person who experiences heavy withdrawal symptoms is in grave physical danger, potentially a life-threatening state, and needs a medical detoxification to withdraw safely.
In the case of addiction to marijuana (yes, marijuana is addicting), it's not the person's body that signals the absence of the substance, but rather their mood. In other words, when a pot addict is not using, their mood "misses" pot.
To avoid or "treat" their physical withdrawal, a chemically dependent person will use their substance of choice to relieve or avoid withdrawal symptoms. A "mood addict" is less discriminating in their method of withdrawal management and will substitute any number of mood-altering substances. To convince themselves or someone looking on that there is not a problem, a common phenomenon and accompanying rationalization is used by the addict and often accepted by those concerned. They "cut back" to less serious drugs. They stop using hard liquor and just drink beer (please note that there is the same amount of alcohol in a shot of liquor, a glass of wine, and a can of beer). Or, they no longer use cocaine and just use pot. In any case, when addiction is present, their efforts to cut back are meaningless. Because mood altering is still taking place, take no comfort in the fact that you or someone you love is switching from one mood-altering substance to another.
These days I spend most of the time in my role as crisis interventionist. For a further understanding of what this means, see my Web site at www.jeffvanvonderen.com. Not too long ago I was called by a family to do an intervention on a family member whose drug of choice was methamphetamine (crystal meth). This forty-one-year-old male and former university professor was living alone. He had constructed an elaborate water filtering system to remove "the mind control agents the city was adding to the water supply." Several closed-circuit television cameras were strategically placed around the property because he was "in danger of being assassinated by the Mexican mafia." He agreed to meet with the family and me, but insisted on leaving the house and going to the hotel where they were staying. While it was only two miles away, it took him more than thirty minutes to get there because he traveled a circuitous route of side streets to lose the FBI, who "have been trailing him" everywhere he goes. Upon arrival at the hotel he wondered if I had noticed the hot-air balloon with "the surveillance camera that was spying on his movements." Believe me when I say that this was not half of the drug-induced paranoia he exhibited over the course of our meeting.
The use of and addiction to methamphetamine is currently very prevalent, at least as far as I can tell from the frequency of calls I receive to help people with this problem. More on this particular drug in a moment. Government agencies and the private sector spend millions of dollars each year studying and trying to make sense of current trends in the use of alcohol and other drugs. Right now I simply want to tell you what I am noticing. The fact that I mention these particular substances is in no way intended to minimize the seriousness of addiction to the ones I don't mention.
CRACK AND COCAINE
Cocaine is a powerfully addictive substance. Users sniff or snort it in powder form, inject it in liquid form, and smoke it as well. Free-base use and smoking crack cocaine involves inhaling the fumes produced (called a "clean burn" as opposed to the "dirty burn" produced when smoking pot), usually in some variation of a small glass pipe. "Crack" is the street name used when cocaine is combined with ammonia or baking soda. It makes a crackling sound when heated. Compulsive cocaine use develops rather quickly.
In the nervous system, cocaine interferes with the function of dopamine, which affects the user's physical movements and pleasurable state. Side effects include dilated pupils and increased blood pressure, temperature, and heart rate. A cocaine habit is very expensive. The high from snorting it may last up to thirty minutes, from smoking perhaps up to ten minutes.
Cocaine users exhibit periods of irritability, restlessness, and anxiety. It is not unusual for an addict to fall further into cocaine use to reach the same kind of pleasure as they did from their very first experience. This form of tolerance accounts for the person's continued use, despite the cost and other harmful consequences. High doses of cocaine, or use over an extended period of time, can produce a state of paranoia. Crack is known to produce violent and paranoid behavior. Snorting cocaine for a prolonged period can cause ulcers in the nose or even cause the septum to perforate. Depression occurs when cocaine use is curtailed. Cocaine overdose can cause cardiac arrest, seizures, and paralyzation of the person's respiratory system.
There is another danger present when using this substance that is little known, even to many cocaine users. Mixing cocaine and alcohol triggers the liver to combine the two substances and create another substance entirely, called cocaethylene. This multiplies the effects of both substances and increases the chances of sudden death. Cocaine-related emergency room admissions exceed those of heroin, as well as methamphetamine.
HEROINHeroin use and addiction is probably the country's most publicized of all drug problems. It seems to me that recently there are more people snorting or smoking it. This might be because users think it is safer than needle use, with regard to transmission of the HIV virus. It is not. On the street it is called smack, skag, junk, H, and other "pet" names by users.
Heroin use has serious health implications, some of which are spontaneous abortion, collapsed veins, liver disease, heart and valve infections, overdose, and staph infections. (I recently saw a woman who looked like a shark-attack victim from the number of staph infections, operations, and skin grafts resulting from use of dirty needles.) Of course, more commonly known problems associated with bad needles are contraction of HIV/AIDS and hepatitis.
An initial surge or rush of pleasure is experienced upon initial use, as well as dry mouth, a heavy sensation in the arms and legs, and a warm sensation on the skin. What is left is a state of alternating periods of alertness and sleepiness. I recently saw this cycle repeat itself several times while on a plane escorting someone to treatment. In this case, the drug that was involved was not heroin but rather morphine (the drug from which it is processed). Withdrawal from the drug produces pain in the bones and muscles, sleep disorder, diarrhea, vomiting, and cold flashes. Sudden withdrawal can sometimes be fatal, although less dangerous than alcohol withdrawal.
MARIJUANAI am choosing to address marijuana in this chapter because it is the most commonly used illicit drug in the United States. Street terms for marijuana (and THC-containing substances) include pot, herb, weed, grass, widow, ganja, and hash. Studies estimate that there are approximately 2.6 million new marijuana users every year. It accounts for the third most common drug-related emergency room admissions each year.
Immediate effects of marijuana use include distorted perception of reality, memory and learning impairment, loss of motor skills, impaired problem-solving ability, and increased heart rate. During the first hour after using marijuana, the user's risk of heart attack goes up more than four times. Long-term marijuana use can cause changes in the brain similar to those seen after long-term use of other major drugs of abuse. Marijuana impairs the user's ability to remember and learn information. Not only does this make daily life more difficult, but it makes it more likely that they will trail others in gaining the knowledge and skills necessary to function in school, job, and social settings.
METHAMPHETAMINEMethamphetamine is a powerfully addictive drug in the stimulant category. It is manufactured in illegal, concealed laboratories from rather inexpensive over-the-counter ingredients, hence it's available for widespread misuse.
Street names of methamphetamine include speed, meth, and chalk. In its smoked form, it is often referred to as ice, crystal, crank, and glass. It is a white, odorless, bitter-tasting crystalline powder. It can be smoked, injected, or ingested. Sometimes the user dissolves the substance in alcohol or water. The effects of methamphetamine can last six to eight hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent behavior. When crystal is smoked, in a glass pipe like crack cocaine, the high can sometimes last more than twelve hours. Even the residue in the pipe can be re-smoked.
If you are dealing with someone using methamphetamine, as with most stimulants, you will observe a pattern of bingeing and crashing, where the person can be awake and active (or overactive) for days, then sleeps for long periods, even days at a time. Specific effects during awake times are increased physical activity and decreased appetite.
Methamphetamine is extremely addictive and toxic. Large doses can raise the body temperature to dangerous, sometimes fatal levels, as well as cause the user to convulse. Violent behaviors, sleep disturbance (even when not using), confusion, and anxiety can also be present. Use over a long period of time can cause a state of drug-induced psychosis. In this state the user will be paranoid, hear voices, see things that aren't there, feel things on their skin that aren't there. The extreme paranoia can result in homicidal (to them, self-protective) and suicidal thoughts and behaviors, as well as increasing isolation from interaction and social contexts. Even after use is curtailed, symptoms can last for months, even years.
ECSTASY (MDMA)Ecstasy is an illegal drug that acts as both a stimulant and hallucinogen, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences. Typically, it is taken by mouth, usually in tablet or capsule form, and its effects last approximately three to six hours. It is not uncommon for many tablets of Ecstasy to contain other drugs, which can have their own harmful effects, including methamphetamine, dextromethorphan, cocaine, or ephedrine. In addition, Ecstasy is rarely used alone, most often with pot or alcohol.
Ecstasy is fast-acting and produces feelings of empathy, emotional and mental stimulation, decreased anxiety, heightened well-being, and increased sensory awareness (perception, touch). On the downside, it can produce raised blood pressure, anxiety, cramping, blurred vision, and nausea. In cases of overdose, the user can experience panic attacks, loss of consciousness, seizures, and heart failure. Withdrawal symptoms include irritability, sadness, depression, disinterest in sex, diminished appetite, and in some cases aggressive behavior.
These are Oxycodone (OxyContin) and Hydrocodone (Vicodin). Like other opioids, they block the transmission of pain messages to the brain. In addition, they can also affect areas of the brain in which we perceive pleasure. They can also produce drowsiness, cause constipation, make it hard to breathe, and in the case of overdose, paralyze respiration and result in death.
Regular use of these drugs can become physically addicting (the body needs the drug), which means that withdrawal symptoms will be experienced when use of the drug is stopped. These can include agitation, cold flashes, muscle and bone pain, sleep disturbance, gastrointestinal problems like vomiting or diarrhea, and muscle twitching.
Over the Counter
Dextromethorphan is an ingredient commonly found in cold and cough medications. However, when a person consumes many times the recommended dose, they can experience hallucinations and symptoms similar to some of the more serious club drugs. Because the drug impairs the user's vision and cognitive abilities, they are at risk of self-injury while under the influence. Physical symptoms of abuse can include vomiting, numbness in the limbs, high blood pressure, irregular heartbeat, and in severe cases of overdose, brain damage, unconsciousness, seizure, and even death. Obviously, taking this drug in combination with other drugs, even legal over-the-counter medications, can magnify the intensity of the effects, as is common with any drugs when legal or illegal are combined.