Friday, November 18, 2005

7. The Addiction Timeline

To understand this disease it is necessary to visualize "The Addiction Timeline".

There are definite stages that an addict goes through from first use to recovery ... or death.Not everyone goes through these stages at the same speed. For some the journey is quick. Others will stay at a certain stage for years before moving on. Yet others start slowly, only speeding up later in life. One thing is certain. All addicts go through the same stages and all addicts either recover or die.

The damage we do to ourselves, our family and our "what might have been" future depends on how soon we quit ... and how well we quit.

Stage One - Experimentation

The first stage of the timeline (or The Electric Highway - the title of my book) is Experimentation. There are some things that are unique to this stage;

  • No one wakes up one morning and just decides to be an addict. What they do decide is to "try" it.
  • No addict was ever introduced to drugs by a pusher or dealer. In every single case, it came from someone close to the addict, a friend or lover.
  • Drugs aren't dangerous! (They will eventually kill you, but that's not the real danger)
  • Drugs are terrific! (and that is the real danger!)

Many parents feel that it's okay for their kids to try drugs or alcohol to satisfy their curiosity. I have met parents who say, "If they want to try it, okay. As long as they do it at home. After all, I experimented in the 60's and I'm not an addict."

But today's drugs are terrific. They wash the mind and the body with ecstasy, with rapture, with an incredible feeling of pleasure that can never be re-created by anything else. A seasoned addict once said to me,

"If you take all the sex you are ever going to have in your whole life and compress it into one single minute, and if you could experience 30 of those minutes, it doesn't even come near the "rush" of heroin or crack."

That is the real danger of experimenting, of just trying it - you will discover how terrific drugs are. You will fall in love with that "electric" rush. You may not plan to try again, but soon, someone else is going to offer you more, and you'll think, "Why not? Just one more time. After all it takes a while to get addicted."

Try it once, and the barriers are down! You will try it again, and again. In fact you may even decide to use recreationally. Recreational drug use is compared to the way adults use alcohol at a wedding or party.

Stage Two - Abuse

Try it once and it is experimentation. Try it twice and it is abuse. The first time you wanted to know what it's like. The second time, you already know what it's like. This time you are using it for the pleasure. Drugs have a role in health care. They can be used for real medical purposes but when they're used for pleasure, it's an abuse of the drug.

So what is really wrong with recreational use of drugs? After all we use alcohol recreationally. Alcohol is an accepted part of the social scene in most societies.

It estimated that 80 million people world-wide have become addicted to "recreational" alcohol. That's the danger of recreational use of drugs or alcohol.

The problem is that, from day one, use of mind-altering substances initiate physiological and psychological changes. As we will see in the next stage of the addiction timeline, even in this "abuse" stage, the body is getting itself aligned for addiction.

How? Within our brains there is an inner brain which I call the lizard brain. This lizard brain exists for only one purpose - to keep you alive! It's reactions are automatic. It's the part of your brain which makes you duck when a ball whizzes towards your head. It makes you dive for cover when there is a loud explosion. It doesn't think. It doesn't reason. It makes every part of your body react to danger.

If we consume a toxic substance, it makes us vomit. If we consume it in small amounts, slowly increasing our intake over a part of time, the lizard brain also by sending out a message to every cell in your body. It says, "There is a dangerous chemical present that you have to flush out."

The body, in turn, obeys and flushes out the poison. If you continue to pollute your body, the lizard brain screams, "Listen up! You have to become more efficient. You have to change and get better at this."

And the body listens. Cells start to change. Their makeup modifies. That's why you will find that you don't get the same "buzz" as you used to get. The body has changed to become better at ridding itself of the drugs or alcohol.

As you drink more beer, take more drugs, the lizard brain makes the body keep up. It does this quietly and without you being aware. Eventually, your body becomes streamlined to deal with these substances and then, when you don't use them, the body says, "Hey! What are you doing? We have become efficient now. We can't function well without the drugs. Consume! Consume!" And you suddenly feel like having a beer - for breakfast!

There are many other things that change (like your brain's neuro-receptors and endorphin production) but you don't know about it. You're too busy partying and "using" to notice. And somewhere along this part of the addiction timeline, you cross over from abuse to addiction. You don't know that it's happened. As far as you're concerned you're still in control. You will only know you have a problem long afterwards, sometimes years after you have caught the disease of addiction.

Besides the danger of crossing over from abuse to addiction, consumption of these mind-altering substances have a direct bearing on poor education, vehicle accidents, violence and abuse, arrests by police for possession (leading to permanent criminal records) and bad life choices in general.

Also, drugs are traded by criminal organizations and those who come into contact with their ecosystem are exposed to shootings, robbery and other violent crimes.

Substance abuse also exposes people to many health issues. For instance, the common practice of "snorting" drugs by sharing rolled up bank notes, spreads nasal mucus from aids and hepatitis infected users to others. Needles spread HIV and the promiscuous lifestyle of the twilight zone exposes everyone to the risks of sexually transmitted diseases and unplanned pregnancy. Even passing a "joint" around opens everyone up to contagious germs and viruses.

Stage Three - Addiction

Once addiction occurs, changes continue. A major area of concern is changes in the brain itself. If one looks at a brain-cell under extreme magnification, we see that there is a thicker part at both ends. To communicate, an electrical impulse whizzes up the length of the brain-cell until it arrives at one of these thicker ends.

To communicate with the next brain-cell, a molecule sized chemical (neuro-transmitter) pops out of one end and jumps across the gap between cells (the synaptic gap) and enters a "receptor" on the adjoining brain-cell which causes another electrical impulse to whiz down that cell's length to the other thickened end where another neuro-transmitter pops out and so on.

Different neuro-transmitters are used for different feelings. For instance, dopamine is the neuro-transmitter associated with pleasure and the receptor that catches dopamine is called the dopamine receptor.

When drugs enter the brain's ecosystem, they try and attach to these pleasure receptors causing an overload of pleasure and ecstasy - the buzz or "high" which addicts seek out. In fact, the receptors get so jammed-up with the foreign chemicals that the brain's normal dopamine molecules have nowhere to go and they simply float around the brain.

Enter the lizard brain to save the day! Seeing the flood of un-used dopamine it yells, "Stop the production lines! There's too much dopamine around. Cut down production ... "and the brain does - often permanently. The result is that even the brain's natural ability to experience joy and pleasure stops and the addict has to rely on drugs for any pleasure at all.

Stage Four - Spiraling

As drug use continues, the body responds by increasing efficiency which in turn calls for more drugs. Drug use rockets and a spiral is created as the body builds tolerance to drugs.

Drug consumption increases to chase the buzz but the body again adjusts. This spiral of addiction loops up and up until huge quantities of drugs or alcohol are needed just to get a simple high.

There is also a sinister by-product of this spiraling. Money. Drugs are expensive. The more drugs used, the more money is needed. At first you will use whatever income you have until a break-even point is reached where income equals expenditure on drugs.

But the spiral of addiction doesn't stop. The next loop usually finds the addict borrowing from family and friends. However, because there there is no way to pay-back, that source of cash soon dries up.

The next loop requires the addict to supplement income by selling his or her possessions. CD's, jewelry, anything that can be sold disappears.

When there is nothing left to sell the addict starts to steal and even sell the family's possessions. Things disappear around the house until there is a blow-up because eventually the family wakes up to the fact that things are missing.

Somewhere around here, the first ultimatums are issued and the first false promises to quit are made.

Stage Six - Social Dysfunction

Now major social dysfunction follows. The addict keeps using and the family keeps issuing ultimatums. Eventually the addict is kicked out of the family home or leaves in a huff.

The addict usually seeks accommodation with other addicts. Now there is a group imperative to use. There are no longer any restraints on the addict and soon he or she slips into the twilight zone completely.

Crime, prostitution and violence become a pattern as the addict chases the buzz. Every single day the addict's total and obsessive focus is on finding ways to get money to buy drugs, and there is nothing an addict will not do.

Female addicts attach themselves sexually to anyone who is a source of drugs. The jump from this to prostitution is very small. Once caught in this activity, escape becomes very difficult especially if under the control of organized crime or a pimp. Women generally don't make good "muggers" or robbers. They gravitate towards shoplifting and selling the only thing they have - themselves.

Stage Seven - Recovery

Eventually a crisis occurs, making the addict seek recovery. This crisis can be any of a number of things ... the addict may become very sick or have a near-death (overdose) experience. If children are involved, removal of the children by social services may cause the crisis. The addict's spouse threatens divorce or jail-time are other possible crisis.

Whatever the reason, it is usually severe. It's called hitting the wall. I believe that that no addict will come into recovery until they have hit the wall, till they have reached rock-bottom, until the pain is greater than the pleasure! Whether this rock-bottom is living in the gutter or severe physical injury, there is a crisis.

Unfortunately, too many addicts die, or cripple themselves physically or mentally before they hit rock-bottom. A technique to bring the bottom closer is "Intervention". Intervention counsellors use their skills to bring about an artificial crisis or hitting of the wall.

Recovery is, however, difficult and usually means several attempts interspersed with relapses until the addict gets it right. In some cases this can take years and many addicts die trying.

To recover requires a few "must-have's."

1. The addict must have a burning desire to quit.

Quitting is hard and the road back is difficult and strewn with mine-fields. If the addict doesn't crave recovery and is only there because he or she has been forced into recovery, success is very low. Only about 2 out of a 100 will recover.

2. The addict must have a sponsor.

Addiction is an insanity. Just as the insane in an asylum don't know they're insane, addicts are not able to recognize their own addictive thinking. All their thoughts and ideas are suspect and they cannot be trusted to manage their own recovery. They have to put themselves in the hands of a sponsor who is sober and clear thinking.

3. The addict must have a program.

Quitting is more than just stopping consumption. Addicts who lock themselves in a hotel room for two weeks while the drugs work themselves out of their bodies, relapse within days of cleaning up. Quitting requires definite programmed steps in a set sequence with specific goals at each stage.

Stage Eight - Relapse

If you decide to join a gym you may find that you were able to all the sets required. However, you can be sure that no matter how well you do, you are going to hurt over the next few days. In fact, you may even decide to give it a rest for a few days until you can cope again and then ... a few days becomes a week and a week becomes a month. Sound familiar?

The same is true with recovery. No matter how well the addict seems to be doing, it is very hard and stressful to quit. Sometimes it is too much and the addict "takes off" from his or her program. This is relapse. Unfortunately, there are many other triggers that will cause a relapse. These range from "using" friends to family interference.

No matter what the causes of relapse, the addict has to apply two behaviors.

First, if you relapse, get back up, dust yourself off and start again. No one will judge you badly because everyone in the program has done exactly the same thing many times.

Secondly, learn about relapse from each episode. "What happened? How far back did I really decide to use again? What was going on in my life at that time? Which of the "Relapse Prevention" rules did I ignore? "

Relapse doesn't weaken - it strengthens. The addict's sponsor will help with this learning process. In fact, often it is the sponsor who first recognizes the warning signs of possible relapse.

To the family I say;

If you make a fuss and point fingers, you will associate yourselves negatively with relapse and your addict will stop trying for fear of the inevitable relapses and associated family scorn, anger and disappointment.

Your addict's sponsor will advise after each relapse how to respond. Sometimes you will have to be tough and sometimes you will have to show compassion

Stage Nine - Maintenance

The last, and in my mind, most important stage in the addiction time-line is "maintenance".

Addiction is for life. It can be arrested but never cured. As any alcoholic with 25 years of sobriety will tell you, it takes just one "sip" (not even a whole drink) just a little sip and it will be over for them. Immediate relapse will occur because the "beast" never leaves.

While the addict is working his or her program, building a new life - the beast is just around the corner doing push-ups, getting stronger ... waiting.

The beast knows that it can't tempt the addict by pushing a bottle in front of him or her, or dropping a small packet of powder on the table. It will be more subtle ... sneakier. It will encourage you to meet old friends or go to places where there may be drugs. It will interfere with your serenity, encourage anger. The beast will make you forget the insanity of when you were using.

To prevent relapse there are activities that are done daily, weekly, monthly and annually. The day you stop these activities is the day the beast steps up to the plate.

I have been clean many years now yet;

Every day I tell myself, "I am an addict and just for today I will not use"

Every week I attend my NA home-group where I serve in any capacity needed from coffee-maker to Chairperson. I might go to other meetings occasionally, but I always go to my home group.

Every month my sponsor and I review my program and set goals for the following month.

Every year I celebrate the anniversary of my first clean day with a cake and a speech at my home group.

Vigilance is the price of our sobriety.


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