‘Man is a knackered ape’, said one child in an exam howler (it should have been ‘naked ape’), but it can so easily be true. When we are under touch stress and we find it hard to unwind and switch off, relaxants such as alcohol, cannabis, or even sleeping pills, sound attractive. It’s so easy to get caught in that trap.
For many people the first taste of addiction comes from seeking something that will increase their energy or decrease their stress, depression and anxiety, which is often caused by sub-optimum nutrition, a lack of sleep and working or playing too hard. At some point you’ll taste the sweetness of sugar and feel its energy-giving effects; or have a strong tea or coffee and feel the lift; or have a cigarette and feel the elevating and relaxing buzz; or the unwinding effect of a glass of wine. Stress itself is a stimulant, promoting the release of adrenalin and cortisol, and many of us become addicted to stress, panic and living on the edge. At least you feel alive – kind of.
When occasional use becomes a need
To begin with this is no big deal – just the occasional use of a substance to change how you feel. But, as we learned in the last chapter, your brain’s chemistry is already changing. You become less sensitive to the substance and therefore need more of it to feel good. Some stop at that one or two coffees a day, or that occasional cigarette, but others don’t. Many people end up hooked and ‘needing’ 20 cigarettes or a dozen cups of tea or coffee to feel kind of normal. For some, even this isn’t enough and the combination of down-regulation (becoming increasingly insensitive to the substance and needing more) and consequent reward deficiency (craving a dopamine high) leads to the desire to try something stronger – maybe cocaine for that extra kick or a more potent relaxant such as more alcohol, or even Valium or heroin if that isn’t enough.
Then there’s the other side of the fence, when you’ve quit something you had become extremely addicted to, such as alcohol, but have substituted it with loads of sugar, stimulant drinks and cigarettes. Although this appears to be a step in the right direction this means your brain chemistry is still out of balance.
The more you have, the more you want
For many people the slippery road to dependency starts with stress, sugar, cigarettes or stimulants such as caffeinated drinks. These all have similar biochemical effects by stimulating the brain’s trio of inbuilt stimulants: dopamine, noradrenalin and adrenalin. These stimulants give you get-up-and-go – at least temporarily – but in the long run they make you more stressed and exhausted.
They are actually ‘worker drugs’, and only really became popular and excessively consumed in the Industrial Revolution, as people started to work harder and harder, driven by the culture of capitalism and competition.
The trouble is, as we have already explained, the more you have the more you want. That one cup of coffee turns into two, then three, then there is the ‘speciality’ coffee that you make yourself in an elaborate ritual that, behind the scenes, means you knock back a triple espresso. That occasional cigarette turns into ten, then 15, then 20 or more. Sweet foods become a constant craving. You become more tired, more stressed and more in need of a fix. Then you need alcohol to relax.
The vicious cycle of stress, stimulants and fatigue
The exhaustion epidemic
Never mind the Industrial Revolution, the technological revolution we live in today has spawned a world that never sleeps. Television, the Internet and even the stock market call to us 24 hours a day, seven days a week. When we shave an hour off our sleep, we feel we’ve gained some small advantage.
Many of us are also trying to keep impossible schedules of work and family responsibilities. And it has a cumulative effect. You struggle to find time with your children, friends and colleagues, not to mention your partner. You’re less alert than you’d like, feeling drowsy as the day wears on, dozing off if you sit down to read or watch TV in the evening. When you finally do get together with your partner at bedtime, neither of you has the energy for anything more than falling asleep.
We turn to chemicals to help us through the day
Too often today we become reliant on chemical ‘helpers’ to keep us going: the frequent coffee breaks, the chocolate bar to satisfy our hunger when we have no time to eat, the cigarette to calm our nerves.
Heavy use of substances like coffee, chocolate and cigarettes can lead to reward deficiency.
Although we might recognise the problems that are created when we use illegal drugs such as heroin, or if we drink to excess, smoke or become hooked on strong prescription drugs, we usually don’t recognise that we can become addicted to caffeine or sugar and that these too can have serious repercussions for our health – dominating our lives and making us feel under par. We believe that we just need a little boost sometimes to get us through the day – despite the fact that if we’re low on energy it might be because we are dependent on stimulants.
How dependent are you on stimulants?
To get an idea of how depleted your natural energy might be and how dependent you are on stimulants, check yourself out in the following questionnaire:
QUESTIONNAIRE: check your energy
Yes No
1. Do you have trouble getting up in the morning?
2. Do you rely on a cup of coffee to get you going in the morning?
3. Do you feel tired all the time?
4. Do you often feel foggy, fuzzy or dull?
5. Do you have trouble concentrating?
6. Do you use sugar, caffeine (tea, coffee, caffeinated cola drinks) or a cigarette as a pick-me-up throughout the day?
7. Are you often irritable or angry, for no apparent reason?
8. Do your moods seem to go up and down for no apparent reason?
9. Are your mood swings often relieved by food, especially sweets?
10. Do you have trouble falling asleep at night?
11. Do you have headaches or shaky feelings that are relieved by sugar, caffeine or cigarettes?
12. Do you suspect you’re addicted to coffee, caffeinated cola, or cigarettes?
13. Do you find yourself operating from crisis to crisis?
14. Are you drawn to thrills, danger and drama in your life?
Score 1 for each ‘yes’ answer.
Total score:
Score
Below 5
You’re doing fine. We all have our moments – bad moods, feeling tired or foggy – when we are in need of a pick-me-up.
Between 5 and 10
You are showing signs of an overdependence on stimulants to keep you going. This next section will explain what is happening in your body, and how to make healthier choices.
More than 10
You are seriously hooked on stimulants, and it is affecting your mental and physical health. It’s important for you to take yourself off them. We will show you how in Part 2.
The see-saw of stimulants and relaxants
If you give in to your cravings for stimulants, it does not necessarily mean you are weak or ‘bad’, but simply that your chemistry is controlling you. You need the right fuel – foods, vitamins and other micronutrients – to run your body’s engine (see Part 2). You also need sufficient sleep to restore body and mind and maintain your energy level. When you turn to stimulants to give you energy, however, they further deplete your already bankrupt system.
The reason they work in the short term but not in the long term is because of what they do to your blood sugar balance, as well as the balance of your neurotransmitters and hormones.
Stress, sugar and stimulants all raise your blood sugar, which can give you a short-term boost in energy. But, in time, your blood sugar level becomes more and more unstable.
One of the reasons for this is that the body becomes less and less sensitive to the hormone insulin, which controls your blood sugar level. So now you need more stimulants to keep you going. Eventually you become dependent on stimulants. It’s a vicious cycle of stress, overuse of stimulants and fatigue. The end result is daily craving – and exhaustion.
Some people start using more potent stimulants such as amphetamines and cocaine to get an extra lift. The more stimulants you use, the harder it is to relax and sleep soundly. Then you need relaxants such as alcohol, sleeping pills, tranquillisers and marijuana to bring you down. This see-saw lifestyle affects performance, promotes stress and depletes your energy.
Handle with care: popular stimulants
As you can see from the diagram on page 90, all stimulants work by mimicking or triggering the release of the three neurotransmitters: dopamine, adrenalin and noradrenalin. That’s what makes you feel motivated and upbeat. We learned in Chapter 3 how down-regulation in the brain eventually puts a stop to the fun of getting high. That’s exactly what happens with stimulants. This overstimulation leads to down-regulation, as receptor sites for dopamine, adrenalin and noradrenalin start to shut down. You keep needing more of the product to l the same effect. But how much is too much, and are there some stimulants we can take safely in moderation?
How stimulants work
Although a substance can be good in one context, it can be harmful in another. In one short-term experiment, coffee was shown to heighten alertness, but you already knew that, didn’t you? And now you know that something can have benefits in the short term but be harmful in the long term.
We’ll deal with these issues as we discuss each substance in detail. But for now let us say that some stimulants are never recommended, whereas others can be acceptable in moderation, depending on the situation.
Sugar: toxic treat
Sugar is a fairly recent entry into the stimulant game. Of course it’s always been available in natural sources such as fruit, with its slow-releasing fructose and fibre. Refined sugar, however, only came in with the Industrial Revolution. Yet today, we can hardly picture a celebration without sweet treats – birthday and wedding cakes, Christmas puddings, Easter chocolates.
How can such a delicious, seemingly harmless children’s treat be so damaging? Rapidly absorbed and broken down into molecules of glucose, it quickly reaches the brain, producing feelings of ‘comfort’ or ‘energy’. Sugar bingeing looks a lot like any other addiction: tolerance develops, and you need more to get the same effect. How serious is that? Furthermore, there’s a strong link between sugar addiction and alcoholism. An illustration of this is a study by addiction researchers from University of North Carolina at Chapel Hill.31 In one study they asked 20 abstinent alcoholic men and 37 non-alcoholic men to taste five sugar solutions. The solutions ranged from not sweet at all to very sweet. Sixty-five per cent of alcoholics preferred the sweetest solution compared to only 16 per cent of non-alcoholics. In another study they found that 19 pairs of twin brothers shared a similar liking for sweets and alcohol despite having quite different life experiences.
The downside of sugar
Sugar is bad for you. Although a valuable fuel for our cells, it can be toxic when consumed in excess, often causing damage to the arteries, kidneys, eyes and nerves.
The body tries to get it out of the blood as quickly as possible, but this can then cause a ‘rebound’ low blood sugar with its own set of problems. Some people feel stimulated immediately after eating it, then become cranky and finally go into a low blood sugar slump.
Individuals who reported drinking more alcohol on occasion and having more alcohol-related problems of No had problems controlling how many sweets they ate.
They were more likely to report urges to eat sweets and craving for them. They also were more likely to report this craving when they felt nervous or depressed, and they believed eating sweets made them feel better. This suggests that the craving for sweets and the urge to drink may stem from the same genes, possibly reward deficiency genes.
Caffeine: brewing up trouble
Found in over a hundred plants, caffeine is consumed primarily in drinks. A half-dozen caffeine-containing plants are more widely used than all other herbal materials combined!
Over a thousand years ago, Muslims used coffee for religious rituals. When the stuff finally reached Europe in the seventeenth century it was seen by the authorities as a dangerous drug. Nonetheless, coffee houses spread, as did dependence on this new drug. The rest is history. Together with tea, it comprises 97 per cent of worldwide caffeine consumption. Some parts of the world use other forms of caffeine – mate, guarana and kola nut – which are now becoming more popular in the West.
Caffeine was first isolated from coffee in 1821. The effects of coffee are more potent than those of caffeine alone since it contains two other stimulants: theophylline and theobromine.
How does it work?
Caffeine boosts mood and energy by blocking the receptors for a brain chemical called adenosine, whose function is to stop dopamine release. With less adenosine activity, you increase dopamine and adrenalin. You then feel alert, motivated and stimulated, although some people will feel uncomfortable and jittery. In 30 to 60 minutes, caffeine reaches its peak concentration. It is then inactivated by the liver, with only half its peak level left after four to six hours. Of course, if your liver function is poor you don’t do this so well.
So where’s the danger? Caffeine is highly addictive. Research shows that consuming as little as 100mg a day can lead to withdrawal symptoms when you stop, including headache, fatigue, difficulty concentrating and drowsiness. It’s worth knowing that while a small cup of instant coffee may contain less than 100mg of caffeine, a large ‘designer’ coffee can contain as much as 500mg – five times the ‘addictive’ dose. Decaf has much less – less than 1mg in a cup.
The downside of caffeine
Overstimulation of the central nervous system, leading to increased risk of heart attacks, irritability, insomnia and rapid and irregular heartbeats.
Elevated blood sugar and cholesterol levels.
Heartburn and other gastrointestinal problems.
Increased risk of fibrocystic breast disease.
Diuresis (excessive urination), which can lead to dehydration.
Used during pregnancy, it increases the risk of birth defects.
Contains tars, phenols, and other carcinogens.
Pesticides are used during growing most coffee beans, and these contain cancer-causing compounds (so choose organic if you choose it at all).
At best, we can say that coffee has minor short-term mental and emotional benefits, but these are not sustained. A study published in the American Journal of Psychiatry observed 1,500 psychology students divided into four categories depending on their coffee intake: abstainers, low consumers (who drank one cup or equivalent a day), moderate (one to five cups a day) and high (five or more cups a day). On psychological testing, the moderate and high consumers had higher levels of anxiety and depression than the abstainers, and the high consumers had a higher incidence of stress-related medical problems coupled with lower academic performance.32
The bottom line? Use in moderation, but preferably not at all.
Tea: not always refreshing
In Britain three times more tea than coffee is drunk every day. In the US the figures are reversed. You can guess why by recalling the historic Boston Tea Party, which preceded the American Revolution. Rather than pay a tea tax to their oppressors across the sea, the colonists dumped boxes of imported tea from British ships into the harbour – and haven’t had much taste for it since.
Tea’s stimulating effects come from caffeine, theobromine and theophylline, the same compounds as in coffee. Because of different methods of preparation and the many varieties of the cultivated plant, the average caffeine content of tea ranges widely. Tea contains less caffeine than coffee. However, even when caffeine levels are matched, the effects of tea and coffee on mood are very different, suggesting that there is another component in tea that may be responsible.33 This may be because tea also contains the natural amino acid L-theanine, a relaxant. Early research suggests that 50mg L-theanine naturally stimulates activity in the brain, known as alpha waves, which are associated with a relaxed but alert mental state.34 A typical cup of tea contains 14–18mg of L-theanine.35 Green tea contains even more, and also has much higher levels of health-promoting antioxidant polyphenols. In addition, green tea may help prevent liver damage and lower the risk of death from a number of diseases, including heart disease and strokes.
Case study PAUL
Paul is a good example of what happens when you have too many stimulants. He was drinking 20 cups of tea a day, each with two sugars, and smoking over 20 cigarettes a day. He had no drive or motivation in life and lacked confidence in himself. After following a low-GL diet (as explained in Chapter 11), plus the right supplements, he has given up cigarettes and caffeine. ‘I feel 100 per cent better. My energy is great. I’m not tired. I feel motivated. My skin is transformed. It’s made a major difference.’
The downside of tea
A strong cup of tea contains as much caffeine as a weak cup of coffee – with all the attendant risks (see page 94).
The tannin content interferes with absorption of minerals.
We recommend tea in moderation, meaning two cups a day, or three cups of green tea.
Colas and caffeinated drinks: ‘cocaine in a can’
A cola drink contains about half the caffeine found in a cup of coffee. The original Coca Cola even contained small amounts of coca (cocaine) – hence the name. Today’s drinks usually contain sugar and colourings, which also act as stimulants. Maybe worse, diet drinks contain the artificial sweetener aspartame (Nutra Sweet), which can be toxically overstimulating to the brain. We have seen people who thought they were ‘going crazy’ with anxiety, insomnia and disordered thinking magically recover when they stopped their diet drinks. Ironically, although touted as a diet product, they can actually cause weight gain. (See www.dorway.com/blayenn.html for information on this chemical.)
However, caffeinated soft drinks that are even stronger, with names such as Jolt or Red Bull, can contain up to 80mg of caffeine per can (that’s more than a weak cup of coffee) and that increases their kick and addictiveness. Shades of the tobacco industry! Red Bull shot to fame in the UK after a newspaper article described it as ‘cocaine in a can’. Children and young people are drinking large amounts of these drinks, especially relative to their weight, thereby exposing their developing brains and bodies to a hazardous substance. Their use, together with alcohol, allows a person to drink more because they stay awake. Never mind illicit drugs, consuming too much junk food and high-sugar, high-caffeine drinks can lead to serious health problems and addictions in children. We often encounter diet cola addicts.
Case study DENISE
Denise became so addicted to Diet Coke she bought a small fridge to keep by her bed so that when she woke up at night she could reach out and grab a can! Coca Cola’s corporate agenda has been to have their products ‘within a hand’s reach osire’ and, in the case of Denise, they had certainly achieved their goal! At her worst she was knocking back 20 a day. She had irritable bowel syndrome (IBS), frequent colds, low energy, poor sleeping and a desire to lose some weight. Her periods were also irregular, often heavy, with cramping. She had headaches twice a week and took painkillers regularly. After three months of following our nutritional programme not only is she caffeine-free, but all her health problems have resolved – and she has lost weight.
The downside of colas
Colas contain caffeine – with all its attendant risks (see The Downside of Caffeine, page 94).
Sugar and colouring are added stimulants, whereas aspartame in diet versions can toxically overstimulate the brain.
New drinks aimed at young people have even higher levels of caffeine.
Other sources of caffeine
Another source of caffeine is guarana, which is sold as a herbal stimulant. The seeds and leaves of the climbing shrub native to Brazil and Uruguay are high in caffeine. A dried paste made chiefly from the crushed seed of guarana has a relatively high caffeine content, ranging from 2.5 to 5 per cent and averaging about 3.5 per cent. To determine how much caffeine there is in any product, you must do your maths. You multiply the total weight of the capsule or powder by the percentage of caffeine or guarana to get the number of milligrams of caffeine per dose. The conclusion regarding its use? Like coffee, it can be overstimulating, and have the same ill effects.
Some medications for the relief of headaches, such as Anadin, contain caffeine. Other caffeine tablets such as Pro Plus and the herb guarana are sold outright as stimulants. With the exception of a moderate intake of caffeine in tea we recommend you limit your intake of caffeine to no more than 100mg a day.
Here are the caffeine levels of some common products:
CAFFEINE BUZZOMETER
>PEP
Coca-Cola Classic 350ml (12fl oz) 35mg
Diet Coke 350ml (12fl oz) 47mg
Red Bull 250ml (8.3fl oz) 76mg
Hot cocoa 150ml (5fl oz) 10mg
Coffee, instant 150ml (5fl oz) 40–105mg
Coffee, espresso, cappuccino, latte 50–175mg
Coffee, filter 150ml (5fl oz) 102–200mg
Coffee, Starbucks (grande) 150mg
Decaffeinated coffee 150ml (5fl oz) 0.3mg
Tea 150ml (5fl oz) 20–100mg
Chocolate cake (1 slice) 20–30mg
Bittersweet chocolate 28g (1oz) 5–35mg
Pro Plus 50mg
30mg
(Source: Centre for Science in the Public Interest www.cspinet.org/new/cafchart.htm, American Beverage Association, 2005, and Journal of Agricultural and Food Chemistry, 2003)
Death by chocolate?
Chocolate’s major active ingredient is cocoa, a significant source of the stimulant theobromine. Research by British psychologist Dr David Benton at the University of Wales in Swansea, showed chocolate to be an excellent mood elevator.36 When he played sad music to a group of students, their mood sank. He then offered them milk chocolate or carob (a natural chocolate substitute that is similar in taste), although they did not know which one they had chosen. The participants found that the chocolate raised their mood, whereas the carob didn’t. Moreover, as their mood fell, their cravings for chocolate increased.
In addition to theobromine – also found in tea and coffee, as we’ve seen – chocolate contains the mood-enhancing stimulant, phenethylamine. Both of these stimulate dopamine production. Even experimental alcohol-loving rats, when given the choice, will replace some of their alcohol intake with chocolate.
The downside of chocolate
Too much chocolate, especially the highly sweetened kind, causes all the problems of going overboard on sugar, including weight gain.
It is often high in the wrong kinds of fats.
The addictive nature of it suggests the development of tolerance, so ‘just one chocolate’ becomes ‘just one more’.
Cocoa beans, like coffee, are grown in countries where pesticide use is unregulated, exposing the consumer to cancer-causing compounds.
However, chocolate does have some redeeming qualities. It is very high in antioxidants. Of all the stimulant vices it’s probably the least bad, provided you eat the pure, dark, preferably organic stuff, not cheap bars full of fat and sugar. Eat chocolate with a minimum of 70 per cent cocoa solids. But, as with any stimulant, if you eat it every day, or find yourself craving it, you’ve gone too far. Keep chocolate as a special treat, not a daily ritual.
Addicted to adrenalin and cortisol
Stress itself is a stimulant, promoting high levels of adrenalin and cortisol, which keeps you alive and alert. Many people get almost addicted to the buzz of adrenalin and have to keep going, fuelled by additional adrenalin and cortisol-related stimulants such as coffee and cigarettes.
Case study KATHY
Kathy was an adrenalin junkie. She was drinking up to 30 cups of coffee a day to keep herself going. She also smoked 10 to 15 cigarettes a day. She was gaining weight and losing sleep. She wasn’t fully awake when she was awake, nor peacefully asleep when she was asleep. Within six weeks of starting our recommended diet, however, plus taking the specific supplements explained in Part 2 (combined in our How to Quit Action Plan), she had given up all caffeine, had stopped smoking, and was feeling loads better. She went to bed at 11pm, instead of 2am, and was waking up feeling refreshed. Three months on she had lost a staggering 20kg (3 stone/44lb) without going hungry. Her energy was greater, her skin looked much clearer and she hadn’t suffered from any colds. ‘I feel so much better. My energy levels are improved, I sleep like a baby, I don’t miss coffee at all and I’m not smoking.’
Nicotine
Alongside caffeine and alcohol, nicotine is one of the three most widely used psychoactive drugs in our society. With no redeeming value ‘smoking will continue as the leading cause of preventable, premature mortality for many years to come’, says the US surgeon-general. According to the World Health Organization nearly 5 million people a year die prematurely as a result of smoking.
Nicotine, the primary stimulant in cigarettes, has a significant effect even in small doses.
If you have ever smoked, can you recall the sensation of your first cigarette? It probably tasted terrible, burned your mouth and lungs (if you actually inhaled), and made you nauseated and dizzy. Those are some of its toxic effects in action. A few more smokes, and for most people the body no longer rebels. In fact you rather like it. In short: you’re hooked.
Nicotine has a complex series of actions, both stimulating and relaxing. For many people it is more addictive than heroin – and is often the hardest addiction to break. It stimulates the adrenals to release adrenalin and cortisol, raising blood pressure and heart rate, and increases gastrointestinal activity. It also acts as a muscle relaxant. (We’ll explore this more in Chapter 21.)
In the brain, nicotine activates the release of dopamine, exhibiting a stimulant effect similar to that of caffeine. It also has a short-term antidepressant effect, although this is most often followed by a rebound depression. In larger amounts, nicotine acts as a sedative, probably because of its effect on serotonin. People trying to kick the tobacco habit describe the accompanying tension and irritability as ‘feeling like you want to jump out of your skin’. They often experience low blood sugar problems, which leads them to overeat and gain weight. The trouble is that smoking keeps your brain’s chemistry hooked in to needing stimulants.
Case study AMANDA
Eleven years ago, after years of drug abuse, Amanda quit heroin, but still felt lousy, with constant low energy, and occasionally got the shakes if she hadn’t eaten. She ‘managed’ her state by smoking up to 40 cigarettes a day, plus caffeinated drinks and sugar or sugary snacks. She often felt anxious and irritable and didn’t sleep well. Within a month of following our recommendations in Part 2 (combined in our How to Quit Action Plan), her energy had rocketed. Twelve weeks later she had quit smoking, avoided caffeinated drinks and sugary foods and definitely felt the benefits. ‘My energy is so much better. I go to bed at 11pm and wake up feeling refreshed. I no longer suffer from mood swings, and I feel much more motivated and less stressed.’ Even after 11 years she was able to ‘rebalance’ her brain’s chemistry in just a few weeks with the right intake of nutrients, both from food and supplements.
The How to Quit programme
Whether you are reading this book because you want to give up caffeine or cigarettes, or have stopped using drugs or drinking alcohol, but still ‘rely’ on stimulants, if you really want to feel great you have to go the whole hog and break out of the sugar-stress-stimulant trap. Just quitting one addictive substance, but continuing others rarely works. You need to eat a diet that balances your blood sugar and take supplements that help ‘reset’ your brain’s chemistry. How to do this is explained in Part 2.
SUMMARY
Nicotine, caffeine and sugar are all stimulants.
The more stimulants you have, the more stressed and tired you become.
Your brain becomes increasingly less sensitive to your own natural stimulants – dopamine, noradrenalin and adrenalin. As a consequence you need more stimulants just to feel normal.
Anyone who has quit an addictive substance but continues to rely on stimulants still has an addicted brain
Friday 30 May 2014
Thursday 15 May 2014
Are you avoiding pain
It’s not just the buzz we go for in mood-altering substances, it’s the anaesthetic. If you’ve had a tough week, or a bust-up with a girlfriend or boyfriend, or are dead bored with your career choice or have no idea what direction to go in life, one way to relieve the pain is to get drunk, get stoned or get out of it. It works. Temporarily you forget whatever it was that was eating you up. Using a substance to blot out emotional pain may or may not lead to addiction. But the more you do it, the higher your risk. Although it is very normal to want to escape pain, it’s important to understand why you are using chemical substances to do it – and to find a safer way.
How pain comes and goes
All thoughts and feelings have a corresponding change in your brain’s chemistry. In Chapter 2 we learned about how our brain’s neurochemistry rewards us for certain behaviours with good feelings, by stimulating the release of serotonin, endorphins and dopamine. The opposite is also true. When something happens that makes us feel bad, it sets up a corresponding craving for something to make us feel better and get those pleasurable endorphins flowing. ‘Hugs not drugs’, says an AA slogan, since both do have the power to up our feel-good neurotransmitters.
These are part of the brain’s natural painkillers. The reason why morphine or heroin, for example, kill pain is precisely because they lock into the brain’s receptors for its own natural painkillers – endorphins. They are released, for example, when you are dying. They make you blissfully unconscious of any hassles in life.
The same thing happens, although to a lesser extent, with alcohol, cannabis and tranquillisers. They switch off anxiety, helping you to chill out and temporarily forget about whatever was such a big deal a minute ago.
The longer you go on using the drug, the less pain relief you get, and the more pain you experience the next day as a consequence.
Pain relief becomes more pain
In the short term drugs all ‘work’. They relieve the pain and make you feel good. But soon they bring their own pain – the pain of withdrawal, largely due to endorphin, serotonin and dopamine depletion, leaving you wanting more of the same.
But that’s just the chemistry of it. As a consequence of learning to avoid painful circumstances by ‘numbing out’ with drugs, situations that you need to deal with often get worse, or you make them worse by saying or doing the wrong thing ‘under the influence’.
What are you avoiding?
Apart from this immediate pain, what are you avoiding when you are using drugs?
Are you bored or unfulfilled in your work or relationship?
Are you betraying yourself by not being who you are, or not standing up for what you believe in?
Are you stuck in a rut and need a change, a new challenge to absorb your desire to learn or make a difference?
Have you accumulated so much ‘stuff’ (fears, disappointments, anger, relationship problems)?
Are you imbedded in your negative patterns and negative self-talk? (Self-talk is how we talk to ourselves, in our minds or out loud. Some of our self-talk is encouraging and constructive. Some of it is negative and discouraging. When you are imbedded in your negative self-talk you behave as if it is true whether or not it is.)
Are you drowning in your sorrows?
Is your depression really accumulated anger without enthusiasm (‘Don’t get sad, get mad!’)?
Are you lonely?
Are you searching for something – something that gives meaning to life – in drugs?
Is it time you did some work on yourself and where you are going, rather than numbing out with one substance or another?
This kind of emotional healing – getting the past out of your future – is for many a vital component of breaking an addictive habit. Finding meaning and purpose in life without drugs is a vital key for some people. For this reason it’s part of our 12 Keys to Unaddicting Your Brain, explained in Part 2. We outline a variety of options to explore, from one-to-one counselling to intensive life-changing training courses (see Chapter 18).
AA has a 12-step process towards recovery; step four is to ‘make a searching and fearless moral inventory of ourselves’. If you follow this, you may better understand what it is that makes the use of a particular drug so attractive to you. In Appendix 1 (which is on our website www.how2quit.co.uk) you will see a list of questions. This is designed to help you identify what it is you’re compensating for, and whether there’s a better way to achieve peace or fulfilment than using your drug of choice. The combination of unaddicting your brain with optimum nutrition (as we explain later), and resolving the issues that leave you feeling unfulfilled, is a powerful step away from a pattern of addiction.
Understanding why you use substances
One incredibly useful way of understanding the natural behaviour of wanting to escape pain is the model of the Doors of Compensation®, described by the psychologist and philosopher Oscar Ichazo.
In an article on drug abuse he says,
Drugs (all of them) can be characterised as ‘energy consumers’, consuming energy at a rate much greater than our natural ability to replace it. As drugs burn all our acculated vitality in short periods of time, the brief exaltation is inevitably followed by depletion of vital energy, felt as the ‘down’, the depressant effect of drugs. Nothing can replace a natural, clean body capable of producing natural and clean vital energy.
The order of damaging drugs
Oscar Ichazo rates the drugs most damaging to our vital energy (explained on page 81) in the following order, from most damaging to the least: alcohol, heroin and opiates, tobacco, cocaine, barbiturates, antidepressants, amphetamines, marijuana and caffeine.
How we keep ourselves psychologically in balance
Ichazo’s model describes nine different ways that we dissipate energy. Stimulants and drugs are just one of these. Compensating in one way or another is completely natural and can be seen as the way we attempt to keep ourselves psychologically in balance. Think of your consciousness – your psyche – as a container. When we react to situations with emotional charge (when things don’t go the way we expected, or when we experience stress in one form or another) the pressure on our psyche increases. To release the pressure we compensate by behaving in a particular way – using one or more of the Doors of Compensation. That’s why, for example, people go boozing on a Friday night as an escape from a stressful week, or take their stress out on the family by being bad tempered, or stuff themselves full of food. Each of these is a way of dissipating energy and reducing the psyche’s tension.
The Doors of Compensation
Understanding how we use these doors of compensation helps to identify sources of stress and allows us to develop healthier ways of staying in balance to support a productive and happy life. Ichazo has developed a one-day training session to help you understand how we all use doors of compensation (see Resources, page 486).
The nine Doors of Compensation
1. Toximania The use of toxic substances, including cigarettes, alcohol and cannabis.
2. Psychosomatic illness Being overpreoccupied with one’s mental and physical health and illness.
3. Overexertion, which might manifest as workaholism or excessive sport.
4. Crime Ways of getting even because you didn’t feel you got a fair deal.
5. Phobia, from dislikes to aversions.
6. Panic Always being in a high-anxiety state and then spreading it to others.
7. Debauchery (excess), which could manifest as excessive intake; for example, with food.
8. Cruelty, which includes being mean, using abusive language and behaviour.
9. Sensuality, which includes excessive sex and over-preoccupation with the pleasures of the senses.
The doors and their domains
Each door of compensation relates to a particular domain where a specific psychological imbalance occurs. For example, when we have stress in the work domain we go into panic. Toximania (the excessive use of toxic substances including cigarettes, alcohol and cannabis) is associated with the domain of our sentiments and feelings. So, having the objectivity to notice which ‘doors’ are attractive to you also shows the aspects of your life where you are generating internal pressure.
Whereas we all use these ways of compensating at different times during every day, the degree to which we use them is also significant. The first degree of use is just occasionally, for temporary satisfaction; the second degree is regularly; the third degree habitually to excess. Using drinking as an example:
The first degree is the odd occasion when you have a couple of drinks after a stressful week.
The second degree is when you drink every day and you are anaesthetised by it.
The third degree is when you habitually drink with drunkenness as the outcome, which is debilitating.
By the third stage such behaviour denotes addiction and represents a continual dissipation of energy and consequent brain chemistry imbalances, which are worsened by poor nutrition.
Foods and drinks that dissipate energy
From the point of view of nutrition, the foods and drinks that are associated with dissipating energy, if used regularly or habitually, are sugar, alcohol, coffee and chocolate. To generate and maintain a good level of energy it is best to either avoid these completely, or at least to get to the point where they are an occasional treat and not a daily prop. (An exception is green and black teas, which have many reported health benefits.)
Overeating
Another way of dissipating energy is to eat too much. Indian lore says we should fill our stomachs with one-half food, one-quarter water and leave one-quarter for the prana, or vital energy. In other words, eat to the point where you are satisfied but not full. This has the effect of energising you, whereas overeating has the opposite effect.
Vital energy
Energy isn’t just about the process of eating food and metabolising it with the aid of oxygen from the air you breathe. Theres another factor, called chi in China, ki in Japan and prana in India, which we explain in Chapter 17. It is also called ‘vital energy’ and it can be experienced through certain exercises and meditations. These exercises can leave you feeling alive and energised, with a delicate sense of vitality that can be directly experienced as heat in the palms of the hands, the feet and in the belly.
Deal with the issues first
So, nutritionally, it is best to avoid all the energy consumers and not to overeat. This will certainly give you more energy to deal with the stress in your life. However, from the psychological point of view, these ‘doors’ are used to relieve internal pressure. So by dealing with the issues that generate the psychological pressure, the need to use energy-depleting third-degree doors of compensation becomes less. In other words, you would need to change how you deal with situations in your life as well as changing what you eat and drink. The two go hand in hand.
SUMMARY
Through the depletion of neurotransmitters and unhealthy changes in brain cell membranes, drugs produce ‘morning after’ pain.
Excessive use of drugs often attracts more problems in life and increasing levels of emotional pain.
In serious addiction the drug no longer delivers pleasure but becomes a source of pain.
Identifying the sources of the pain you seek to avoid, releasing accumulated emotional charge, and finding fulfilment without drugs is an important part of the way out of an addictive process, together with optimum nutrition for restoring the brain’s non-addictive chemistry.
All drugs deplete energy.
We often use drugs to release internal pressure or pain, to compensate
How pain comes and goes
All thoughts and feelings have a corresponding change in your brain’s chemistry. In Chapter 2 we learned about how our brain’s neurochemistry rewards us for certain behaviours with good feelings, by stimulating the release of serotonin, endorphins and dopamine. The opposite is also true. When something happens that makes us feel bad, it sets up a corresponding craving for something to make us feel better and get those pleasurable endorphins flowing. ‘Hugs not drugs’, says an AA slogan, since both do have the power to up our feel-good neurotransmitters.
These are part of the brain’s natural painkillers. The reason why morphine or heroin, for example, kill pain is precisely because they lock into the brain’s receptors for its own natural painkillers – endorphins. They are released, for example, when you are dying. They make you blissfully unconscious of any hassles in life.
The same thing happens, although to a lesser extent, with alcohol, cannabis and tranquillisers. They switch off anxiety, helping you to chill out and temporarily forget about whatever was such a big deal a minute ago.
The longer you go on using the drug, the less pain relief you get, and the more pain you experience the next day as a consequence.
Pain relief becomes more pain
In the short term drugs all ‘work’. They relieve the pain and make you feel good. But soon they bring their own pain – the pain of withdrawal, largely due to endorphin, serotonin and dopamine depletion, leaving you wanting more of the same.
But that’s just the chemistry of it. As a consequence of learning to avoid painful circumstances by ‘numbing out’ with drugs, situations that you need to deal with often get worse, or you make them worse by saying or doing the wrong thing ‘under the influence’.
What are you avoiding?
Apart from this immediate pain, what are you avoiding when you are using drugs?
Are you bored or unfulfilled in your work or relationship?
Are you betraying yourself by not being who you are, or not standing up for what you believe in?
Are you stuck in a rut and need a change, a new challenge to absorb your desire to learn or make a difference?
Have you accumulated so much ‘stuff’ (fears, disappointments, anger, relationship problems)?
Are you imbedded in your negative patterns and negative self-talk? (Self-talk is how we talk to ourselves, in our minds or out loud. Some of our self-talk is encouraging and constructive. Some of it is negative and discouraging. When you are imbedded in your negative self-talk you behave as if it is true whether or not it is.)
Are you drowning in your sorrows?
Is your depression really accumulated anger without enthusiasm (‘Don’t get sad, get mad!’)?
Are you lonely?
Are you searching for something – something that gives meaning to life – in drugs?
Is it time you did some work on yourself and where you are going, rather than numbing out with one substance or another?
This kind of emotional healing – getting the past out of your future – is for many a vital component of breaking an addictive habit. Finding meaning and purpose in life without drugs is a vital key for some people. For this reason it’s part of our 12 Keys to Unaddicting Your Brain, explained in Part 2. We outline a variety of options to explore, from one-to-one counselling to intensive life-changing training courses (see Chapter 18).
AA has a 12-step process towards recovery; step four is to ‘make a searching and fearless moral inventory of ourselves’. If you follow this, you may better understand what it is that makes the use of a particular drug so attractive to you. In Appendix 1 (which is on our website www.how2quit.co.uk) you will see a list of questions. This is designed to help you identify what it is you’re compensating for, and whether there’s a better way to achieve peace or fulfilment than using your drug of choice. The combination of unaddicting your brain with optimum nutrition (as we explain later), and resolving the issues that leave you feeling unfulfilled, is a powerful step away from a pattern of addiction.
Understanding why you use substances
One incredibly useful way of understanding the natural behaviour of wanting to escape pain is the model of the Doors of Compensation®, described by the psychologist and philosopher Oscar Ichazo.
In an article on drug abuse he says,
Drugs (all of them) can be characterised as ‘energy consumers’, consuming energy at a rate much greater than our natural ability to replace it. As drugs burn all our acculated vitality in short periods of time, the brief exaltation is inevitably followed by depletion of vital energy, felt as the ‘down’, the depressant effect of drugs. Nothing can replace a natural, clean body capable of producing natural and clean vital energy.
The order of damaging drugs
Oscar Ichazo rates the drugs most damaging to our vital energy (explained on page 81) in the following order, from most damaging to the least: alcohol, heroin and opiates, tobacco, cocaine, barbiturates, antidepressants, amphetamines, marijuana and caffeine.
How we keep ourselves psychologically in balance
Ichazo’s model describes nine different ways that we dissipate energy. Stimulants and drugs are just one of these. Compensating in one way or another is completely natural and can be seen as the way we attempt to keep ourselves psychologically in balance. Think of your consciousness – your psyche – as a container. When we react to situations with emotional charge (when things don’t go the way we expected, or when we experience stress in one form or another) the pressure on our psyche increases. To release the pressure we compensate by behaving in a particular way – using one or more of the Doors of Compensation. That’s why, for example, people go boozing on a Friday night as an escape from a stressful week, or take their stress out on the family by being bad tempered, or stuff themselves full of food. Each of these is a way of dissipating energy and reducing the psyche’s tension.
The Doors of Compensation
Understanding how we use these doors of compensation helps to identify sources of stress and allows us to develop healthier ways of staying in balance to support a productive and happy life. Ichazo has developed a one-day training session to help you understand how we all use doors of compensation (see Resources, page 486).
The nine Doors of Compensation
1. Toximania The use of toxic substances, including cigarettes, alcohol and cannabis.
2. Psychosomatic illness Being overpreoccupied with one’s mental and physical health and illness.
3. Overexertion, which might manifest as workaholism or excessive sport.
4. Crime Ways of getting even because you didn’t feel you got a fair deal.
5. Phobia, from dislikes to aversions.
6. Panic Always being in a high-anxiety state and then spreading it to others.
7. Debauchery (excess), which could manifest as excessive intake; for example, with food.
8. Cruelty, which includes being mean, using abusive language and behaviour.
9. Sensuality, which includes excessive sex and over-preoccupation with the pleasures of the senses.
The doors and their domains
Each door of compensation relates to a particular domain where a specific psychological imbalance occurs. For example, when we have stress in the work domain we go into panic. Toximania (the excessive use of toxic substances including cigarettes, alcohol and cannabis) is associated with the domain of our sentiments and feelings. So, having the objectivity to notice which ‘doors’ are attractive to you also shows the aspects of your life where you are generating internal pressure.
Whereas we all use these ways of compensating at different times during every day, the degree to which we use them is also significant. The first degree of use is just occasionally, for temporary satisfaction; the second degree is regularly; the third degree habitually to excess. Using drinking as an example:
The first degree is the odd occasion when you have a couple of drinks after a stressful week.
The second degree is when you drink every day and you are anaesthetised by it.
The third degree is when you habitually drink with drunkenness as the outcome, which is debilitating.
By the third stage such behaviour denotes addiction and represents a continual dissipation of energy and consequent brain chemistry imbalances, which are worsened by poor nutrition.
Foods and drinks that dissipate energy
From the point of view of nutrition, the foods and drinks that are associated with dissipating energy, if used regularly or habitually, are sugar, alcohol, coffee and chocolate. To generate and maintain a good level of energy it is best to either avoid these completely, or at least to get to the point where they are an occasional treat and not a daily prop. (An exception is green and black teas, which have many reported health benefits.)
Overeating
Another way of dissipating energy is to eat too much. Indian lore says we should fill our stomachs with one-half food, one-quarter water and leave one-quarter for the prana, or vital energy. In other words, eat to the point where you are satisfied but not full. This has the effect of energising you, whereas overeating has the opposite effect.
Vital energy
Energy isn’t just about the process of eating food and metabolising it with the aid of oxygen from the air you breathe. Theres another factor, called chi in China, ki in Japan and prana in India, which we explain in Chapter 17. It is also called ‘vital energy’ and it can be experienced through certain exercises and meditations. These exercises can leave you feeling alive and energised, with a delicate sense of vitality that can be directly experienced as heat in the palms of the hands, the feet and in the belly.
Deal with the issues first
So, nutritionally, it is best to avoid all the energy consumers and not to overeat. This will certainly give you more energy to deal with the stress in your life. However, from the psychological point of view, these ‘doors’ are used to relieve internal pressure. So by dealing with the issues that generate the psychological pressure, the need to use energy-depleting third-degree doors of compensation becomes less. In other words, you would need to change how you deal with situations in your life as well as changing what you eat and drink. The two go hand in hand.
SUMMARY
Through the depletion of neurotransmitters and unhealthy changes in brain cell membranes, drugs produce ‘morning after’ pain.
Excessive use of drugs often attracts more problems in life and increasing levels of emotional pain.
In serious addiction the drug no longer delivers pleasure but becomes a source of pain.
Identifying the sources of the pain you seek to avoid, releasing accumulated emotional charge, and finding fulfilment without drugs is an important part of the way out of an addictive process, together with optimum nutrition for restoring the brain’s non-addictive chemistry.
All drugs deplete energy.
We often use drugs to release internal pressure or pain, to compensate
Sunday 11 May 2014
Are you ready to quit??
Whatever it is that you ‘need’ in order to feel good, there’s something that doesn’t feel right about having to consume a certain substance to feel OK. You’ve probably also found that the original kick you got from the substance you use isn’t nearly as good as it used to be. It just doesn’t fill that need any more. You might even have noticed that the substance doesn’t actually make you feel good at all 09 just less bad. The ‘joy’ of the substance has become partly or wholly the fact that it brings relief, however temporary. You might also have found that your relationship with your substance actually causes you problems or gets in the way of your ability to function in the world in one way or another.
What’s your addiction?
Take a look at the list of substances opposite. Ask yourself honestly which of these you consume on a regular basis, either weekly, daily or several times a day (tick the box). Or, if you are reading this because you are concerned about a friend, find out as best you can about what he or she consumes.
Weekly Daily Several times a day
Caffeine
Sugar
Alcohol
Nicotine
Marijuana
Sleeping pills
Tranquillisers
Antidepressants
Painkillers
Stimulants (such as Ritalin)
Cocaine or other stimulant drugs
Heroin
Ecstasy (MDMA)
Other
Now, take the first substance you ticked and ask yourself this simple question: How would you feel if you quit this substance completely for the next fortnight?
If you wouldn’t be able to quit we could say that you are addicted. Another definition of addiction is that you continue to use the substance despite it having harmful consequences – on yourself, your work or your relationships. If you could quit but you know you’d feel rough, we would say that you are dependent.
Now look at the list on page 16 and tick the appropriate column so that you have a record of your relationship with these potentially addictive substances. If, on the other hand, you have already quit one or all of these substances and still feel rough, with low energy, mood swings and a feeling of emptiness, tick the box labelled ‘still suffering’. What you tick is your baseline.
Dependent Addicted Still suffering
Caffeine
Sugar
Alcohol
Nicotine
Marijuana
Sleeping pills
Tranquillisers
Antidepressants
Painkillers
Stimulants (such as Ritalin)
Cocaine or other stimulant drugs
Heroin
Ecstasy
Other
Take a photocopy of this page and have a look at it again when you’ve completed our How to Quit Action Plan (as detailed in Part 4). We hope that there will be no more ticks in these boxes, if that’s what you want. The advice in this book will also help you recover your joie de vivre – a lack of which leads many towards using mind-altering substances in the first place.
Of course, we are not proposing that all of these substances must be avoided by everybody all the time. For most, the occasional coffee, sugary food or alcoholic drink is perfectly OK. Assuming you are not a recovering alcoholic, and if you can occasionally partake without triggering a need to do it over and over or gradually increase the amount you consume, good. If not, then an appropriate goal for you would be to abstain completely from the substance that is a problem for you.
A culture of addiction?
In Britain alone it is estimated that there are over 10 million smokers, and the same number of ex-smokers, whereas six and a half million people drink harmful levels of alcohol. In terms of serious consequences a person dies every month from ‘E’ pills and amphetamines; a person dies every day from heroin or methadone, every 20 minutes from alcohol and every four minutes from the consequences of smoking.
Not only is the use of these potentially addictive substances going up and up, especially in the Westernised countries, but so too is the amount we spend on them daily. Some of us spend as much on these substances as wd-a on food. Why?
The answer, most of the time, is that we think or hold on to the belief that they make us feel better – happier, less stressed, more energised, more ‘connected’, more relaxed or in less pain. The trouble is, the more you have, the more you need (that’s the first criterion of addiction: you become tolerant to its effects), and the more you need the worse you feel when you don’t have it (that’s the second criterion: withdrawal symptoms). Both tolerance and withdrawal happen because these substances change the way your brain’s chemistry works until you end up programmed for craving and addiction.
Why haven’t you quit?
The chances are you’ve tried to give up the substance or cut down many times. In the beginning you thought you could just do it with willpower but, despite having the motivation and will, after a few days or weeks, you were back where you started. Why?
Why, despite all your good intentions, did you start using the substance again when you’d decided to stop completely? It probably doesn’t even make sense to you that if your feel-good substance is no longer giving you the same pleasure it used to, or if it is creating some kind of problems in your life, you choose to keep using it or keep going back to it.
The answer is simple, and one of the main messages of this book:
When you quit, you experience what we call ‘abstinence symptoms’, which may be more difficult for you to tolerate than the problems that result from continuing or going back to your substance of choice.
The other important message of this book is that there is a way out – it is possible to quit and not feel s**t.
Someone may have told you that you might feel lousy for a few days, but then you would feel better. But that didn’t happen for you. And then, did your desire for the substance overpower your desire to quit? Do you feel a failure because you can’t do something you know you should? Despite your desire to quit, is there a niggling voice in your head that says you’ll never succeed? You’ll soon discover, as you continue to read, that what happens to you when you use a mood-altering substance and what happens when you don’t is a result of changes in your brain. The very nature of addictive substances, and the way they reprogramme the instinctive and emotional part of the brain, is a far stronger influence on your behaviour than your rational mind. Unless you reprogramme your brain’s chemistry away from dependency, quitting becomes difficult, if not impossible – and at the very least, certainly uncomfortable. Strong, instinctive and largely unconscious forces – sometimes as strong as the survival instinct itself – are at work to keep you consuming your feel-good substance. But once you understand the dynamics, and how to change them, it gives you power to control these seemingly irresistible cravings.
You are not alone
If you struggle to feel yo, or less bad, without a smoke, something sweet, something to drink, or some other substance, you are not alone. Addiction or dependence affects most of us at one level or another. The use of addictive substances, whether caffeine in tea and coffee, or alcohol and cigarettes, is part of everyday life for most of us. Most people are somewhere along the continuum from mildly dependent to seriously addicted.
Many of us use a combination of substances to change how we feel: sugar, alcohol, nicotine, caffeine or prescription drugs (to name the legal ones). We harshly judge the use of illegal drugs, such as cannabis, cocaine, amphetamines, heroin and Ecstasy, but your brain doesn’t care whether a substance is legal or not. All of these substances contribute to scrambling your brain’s chemistry.
The addiction epidemic
In Britain, despite all the campaigns, taxes and over 100,000 smoking-related deaths each year, one quarter of all adults smoke.1 We drink an average of 16 units of alcohol a week – that’s 4.5 litres (8 pints) of beer.2 A third of 16 to 24 year olds smoke and their average alcohol intake is 18 units a week – more than two bottles of wine. Collectively we drink 70 million cups of coffee every day – the equivalent of two each for adults.3 One-quarter of our water intake is from caffeinated tea.4 In one survey of over 5,000 people, the average caffeine intake per day was 241mg (a regular coffee or strong tea is about 100mg).5 Most of us are having at least three stimulant drinks a day. And some of us are drinking a few cups more to make up for those who don’t drink any.
An estimated 7.5 million people in the UK have used cannabis, and up to 2 million do so on a regular basis.6 One in ten of the UK population use one or more illicit drugs.7 In the UK the number using cocaine has doubled in the last five years to over 1 million people.8
In America 22 million people are classified with substance abuse or dependence problems.9 Seven million children in the US take stimulant drugs (usually for attention or hyperactivity problems) – that’s roughly one in five.10 In Britain 359,000 prescriptions were written out for just two (Ritalin and Concerta) in 2004.11 In the UK there’s an estimated 1.7 million tranquilliser addicts (that’s benzodiazepines alone) and 31 million antidepressant prescriptions written annually. The number of people addicted to them is unknown. Over 180,000 people seek addiction treatment each year.12
ESTIMATED NUMBER OF PEOPLE DEPENDENT/ADDICTED
(per cent of UK population)
Nicotine 15 million (25%)
Caffeine 12 million (20%)
Alcohol 4.6lion (8%)
Tranquillisers 1.5 million (2.5%)
Heroin 150,000 (0.25%)
Cocaine 20,000 (0.03%)
(Sources: Ash, Drug Scope, Alcohol Concern, Department of Health, NHS)
But am I addicted?
Addiction to any substance is a serious problem. Perhaps you think because you do not consume illegal drugs or are not an alcoholic that you are not addicted or that your heavy use of nicotine, caffeine or sugar is not a problem. The proof is in the pudding: if you’ve tried to kick the habit but ended up feeling so bad you start using the substance again, then you’re probably addicted. The longer you’re addicted the more your brain’s chemistry changes, the less effective the substance becomes and the stronger your desire grows to keep using it. It’s a vicious circle.
Abstinence symptoms: why quitting is so hard
As we have said, there are symptoms of addiction that occur while you are using a substance, but even more distressing for most people are those that occur when they stop using the substance. We have already explained a little about these symptoms and that we refer to them as abstinence symptoms. These can vary from mild to extremely severe, and they are the reason that most people fail to stick with their attempts to quit.
Acute withdrawal: symptoms when you first stop
The first symptoms that occur when you quit a substance are related to acute withdrawal, and in most cases are the opposite of the effects of the substance. For example, if you are using a substance that stimulates you, when you stop you will feel a lack of energy: lethargy, drowsiness, fatigue. If, on the other hand, you have been using a substance that relaxes you, when you stop you will probably feel a high level of agitation, anxiety and jitteriness. Some substances, like nicotine, do both, and quitting brings on a mixture of withdrawal effects. (If you have a severe addiction to a drug with relaxing effects – such as alcohol, a painkiller or an anti-anxiety drug – it may not be safe to stop taking it suddenly and we would strongly recommend that you get medical support.)
Most of the acute withdrawal symptoms will subside within three to ten days. And most people can make it through those, expecting that then the worst is over and they are in the clear. However, what happens next is that other symptoms will begin to emerge, lasting weeks, months or even years if you don’t know what to do to reduce or eliminate them. Some of these may actually become worse over time. The most common ones are listed in our Scale of Abstinence Symptoms Severity on page 26. But before you look at it we will describe in some detail a few of the symptoms that tend to be the most baffling and distressing over time. In Part 2 we’ll show you how to quit without experiencing these symptoms.
Hypersensitivity: when everything is too much
One of the most common abstinence symptoms is hypersensitivity to everything. Put simply, you have heightened sensitivity to external and internal stimuli: noise, light, touch, pain and stress. People who experience this most intensely are unable to filter out background noises and happenings, and this causes them to feel bombarded by all that is going on around them. If you are troubled by this, you feel constantly overwhelmed by everything going on around you and by all your internal thoughts and feelings. What would usually be considered mild stress becomes major stress. Sounds that others do not notice become major distractions for you. Pain is more intense, and simply being touched can even sometimes feel like being mauled. People who are the most troubled by this feel overwhelmed by a world that comes at them full force.
In most cases this particular symptom is partly genetic. Alcoholics, children of alcoholics and those with attention deficit hyperactivity disorder (ADHD) have been found to ‘magnify perceptual input’ (magnify everything their senses experience) and this has been associated with craving for a mood-altering substance.13 It commonly exists prior to using an addictive substance and probably contributes to the risk that someone will use mood-altering substances at an early age. For some, certain substances, including alcohol, make this symptom disappear. So it would be expected that people plagued by it from childhood would use a substance that offers relief and that they would experience it again when they quit.
You find it difficult to concentrate
Although the inability to concentrate can result from any number of brain disturbances when you quit a substance, it can also be, and often is, related to hypersensitivity. When the buzzing of a fly demands as much attention as the person talking to you, it is difficult to stay focused on what that person is saying. It’s not rudeness and it’s not intentional. It is just very difficult to maintain a focus when everything around you is calling to you at the same time. It can be frustrating and embarrassing to realise that someone is talking to you but you haven’t taken it in.
Your memory becomes poor
Problems with memory result from the inability to concentrate. If you didn’t take in what someone said to you or were distracted when it occurred, you won’t remember it. Or the memory will be sketchy. You can’t recall what was never really recorded in your brain in the first place. Memory problems can also be related to fuzzy thinking, which often occurs when neurotransmitters in the brain are not communicating properly (we explain how neurotransmitters work in Chapter 2). It is hard to remember what you haven’t grasped in the first place.
Your mood changes
You may experience anxiety, depression or both as a result of quitting. A certain amount of psychological stress is expected when change is going on. Change is stressful, and it is normal to have some fear connected with quitting your feel-good substance. But stress is exacerbated to the point of anxiety by hypersensitivity and the inability to concentrate and remember.
Maybe what you feel is not what you would really call depression, but is just a general feeling of discomfort or unpleasantness, an inability to feel pleasure. You feel that the colour has gone out of life. Sometimes these feelings come and go and take the form of mood swings. One day you feel good and then soon feel very ‘down’. The tendency is to believe when you’re feeling good that you are always going to feel good; it’s then disheartening when you are again overcome by the inability to feel pleasure.
You crave substances to change your mood
Intense cravings, or what some refer to as ‘drug hunger’, is a powerful compulsion to alter one’s mood with a substance. The abstinent person experiencing cravings knows what will bring relief. Hypersensitivity has been linked to a strong craving for alcohol, drugs and sweets. And alcohol, drugs and sweets normalise it. Feeling incomplete or inadequate or unfulfilled is common with abstinence from any substance that you have used to satisfy you. You experience a feeling of emptiness and a yearning for something, anything, to fill up the emptiness.
You have trouble sleeping
Many people experience sleep problems when they quit addictive substances. A common problem for abstinent alcoholics in early recovery, for example, is unusual or disturbing dreams. This is probably because alcohol suppresses REM sleep. This is the stage of sleep when we dream. And when we miss REM sleep our body tries to make up for it when we do begin to get dream sleep. The same is true with cannabis. This results in a rebound effect and we dream more than normal.
People who quit using other substances have other problems, such as having trouble getting to sleep and/or staying asleep. If this happens to you, you will probably feel sleepy in the daytime or feel tired all the time. Some people experience a difference in their sleep patterns, sleeping for long periods of time or sleeping at different times of the day.
The most serious sleep problems are associated with withdrawal from sleeping pills or benzodiazepines (like Valium and especially Xanex or Klonopin).
CAUTION It is dangerous to come off these drugs suddenly; you should taper off gradually. If you withdraw too rapidly, you may go for long periods without sleeping at all or worse, slip into a coma and die. For this reason we strongly recommend that you seek experienced medical help when tapering off any benzodiazepine.
Record your symptoms to monitor your recovery
Take a look at the Scale of Abstinence Symptoms Severity on the following pages. These are the most common symptoms that people experience when they quit and their brain chemistry is still in dependency mode. Even if you quit something months or even years ago your brain may still be out of balance and you may continue to experience some of these symptoms. Of course, not everyone who quits suffers from all these symptoms. What symptoms you have and how severe they are depends partly on what drug you have used and partly on your own biochemistry. Although we talk about these as ‘abstinence’ symptoms, sometimes it’s these kinds of symptoms that lead you to use a substance in the first place to provide relief. Your brain chemistry can lilly be out of balance from birth.
Here are some guidelines for getting and evaluating your abstinence severity score:
1. Use the scale to find your score when you have quit, because if you are still using your feel-good substance, your score will not give you the correct picture. This is because the substance is changing how you feel. The question is how you feel when you are not using it. So, use the checklist to determine your score after you have not used your substance(s) for at least one day.
2. If you are going through a medical detox for alcohol or other drug withdrawal, find your score when you are through the acute withdrawal phase.
3. Circle the number that best indicates the severity of each symptom you are experiencing today while you are no longer using your mood-altering substance.
SCALE OF ABSTINENCE SYMPTOMS SEVERITY
Circle the number that best indicates the severity of each symptom you are experiencing today (zero indicates the absence of the symptom, 10 represents an extreme, intolerable intensity level). Answer each question as honestly as possible.
Low level High level
Craving or drug hunger 0 1 2 3 4 5 6 7 8 9 10
Craving for sweets/sugar/bread 0 1 2 3 4 5 6 7 8 9 10
Craving for salt 0 1 2 3 4 5 6 7 8 9 10
Loss of appetite 0 1 2 3 4 5 6 7 8 9 10
Overeating/always hungry 0 1 2 3 4 5 6 7 8 9 10
Bloating or sleepiness after eating 0 1 2 3 4 5 6 7 8 9 10
Sense of emptiness/incompleteness 0 1 2 3 4 5 6 7 8 9 10
Anxiety 0 1 2 3 4 5 6 7 8 9 10
Internal shakiness 0 1 2 3 4 5 6 7 8 9 10
Restlessness 0 1 2 3 4 5 6 7 8 9 10
Impulsiveness/acting before thinking 0 1 2 3 4 5 6 7 8 9 10
Difficulty concentrating/focusing 0 1 2 3 4 5 6 7 8 9 10
Fuzzy thinking/head cloudy/ brain fog 0 1 2 3 4 5 6 7 8 9 10
Memory problems/memory loss 0 1 2 3 4 5 6 7 8 9 10
Depression 0 1 2 3 4 5 6 7 8 9 10
Mood swings 0 1 2 3 4 5 6 7 8 9 10
Negative self-talk 0 1 2 3 4 5 6 7 8 9 10
Irritability/impatience with people 0 1 2 3 4 5 6 7 8 9 10
Daytime sleepiness/drowsiness/ dozing off 0 1 2 3 4 5 6 8 9 10
Problems getting to or staying asleep 0 1 2 3 4 5 6 7 8 9 10
Fatigue/lack of energy/worn out 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to stress 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to sound or noise 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to pain 0 1 2 3 4 5 6 7 8 9 10
Dry mouth/dry eyes/dry skin 0 1 2 3 4 5 6 7 8 9 10
Aches/muscle or joint pain/ headaches 0 1 2 3 4 5 6 7 8 9 10
Add up your total score:
When did you first experience the symptoms?
Although we call these ‘abstinence symptoms’, you may have had some of them before you got hooked. Perhaps the substance you became addicted to was the one that worked best to relieve those symptoms. In other words, the symptoms can be the reason you began using the substance in the first place, or they can be the consequence of substance overuse. Which way is it for you? If it is that the symptoms existed before and you used a feel-good substance to relieve them, then they will return even more intensely when you stop using that substance, depending on the degree of damage to your nervous system caused by the substance.
Whether the symptoms are cause or effect, if you have quite a few of these symptoms when you attempt to clean up your act, it’s time to do something about it. If you are still unsure whether or not you are ready, ask yourself this:
Would you be ready to quit if you knew you didn’t have to go through the discomfort you experienced when you tried to quit in the past?
See how your symptoms improve
Most people who follow our programme cut their abstinence symptom score by at least a third within one week, and by a half to three-quarters within four weeks simply by tuning up their brain chemistry with our How to Quit programme. And that’s the big secret to quitting successfully: creating a level of health and a state of mind free from craving and discomfort.
Are you still unsure if you are really addicted?
Many people tell us that they consume substances on a regular basis, get great joy or satisfaction from doing so, and therefore can’t be addicted or dependent. Well, that would depend upon your definition of addiction. As we have been pointing out, addiction is not just about what happens when you use a substance, but what happens when you don’t. When we talk about addiction or dependency in this book we are talking about a condition in which there is a compulsion to keep using a substance despite negative consequences, as well as withdrawal symptoms when regular use ceases.
Of course, you can have negative consequences with or without compulsive use and withdrawal symptoms. The substances we are focusing on are harmful in a number of ways even if we are not addicted to them. Many people who are not addicted drink more than they should and may sometimes drink irresponsibly. Caffeine and sugar in excess are not good for us whether or not we are addicted. The big question is whether or not you can easily give them up when it becomes apparent that it is wise to do so.
Case study SARAH AND KENNY
Let’s take two people who enjoy sweets and eat them on a regular basis. They both begin to gain weight and to have some health problems. They both decide to lose weight. Sarah, who is not addicted, is able to reduce or perhaps eliminate sweets from her diet. She loses weight and enjoys the accomplishment of controlling the amount of sugar she consumes. Kenny stops eating sweets only briefly before going back again and again to the same pattern of eating. He gradually increases the amount he eats and ultimately develops diabetes. Despite his weight and physical problems he is unable to control his sugar intake. He is addicted to sugar.
Most people feel tired and stressed as a consequence of too much sugar, caffeine, alcohol or cigarettes. Yet the addicted brain says ‘have a coffee/have a drink/have something sweet/have a cigarette – it will make you feel good.’ If you recognise that these substances are harming you and you can make the choice to stop using them without craving and discomfort – or if you are able to limit them to occasional use (not likely in the case of cigarettes) – you are probably not addicted. But if you continue to consume the substance despite ongoing negative consequences, and if you feel lousy when you quit, you are addicted and need to do something about it.
You can let go
If you are ready to quit, we have a How to Quit programme to help you. In most cases this takes 12 weeks to complete – defined as being free from abstinence symptoms. We will show you how to free yourself from the hold your substance of choice has on you. If you are not sure whether you are ready to give it up, come along with us. Find out what can happen if you choose to quit. We will show you that it really is possible to quit without feeling s**t, with this amazingly successful, scientifically based programme.
SUMMARY
If you are dependent on a substance – caffeine, sugar, nicotine, alcohol, or prescription or illicit drugs – you are not alone. Most of us have some type of dependency.
You may have given up using the substance you are dependent on but suffer from a variety of symptoms we call abstinence symptoms – listed in the Scale of Abstinence Symptoms Severity.
You may have had some of your symptoms before you started using an addictive substance and then found that the substance relieved them.
Whether the symptoms are a cause or a result of using the substance, if you have a number of them, or if the ones you have are very severe, you can do something about them.
The How to Quit programme we describe in Part 4 will help free you from the discomfort of abstinence and prevent you returning to addictive use
What’s your addiction?
Take a look at the list of substances opposite. Ask yourself honestly which of these you consume on a regular basis, either weekly, daily or several times a day (tick the box). Or, if you are reading this because you are concerned about a friend, find out as best you can about what he or she consumes.
Weekly Daily Several times a day
Caffeine
Sugar
Alcohol
Nicotine
Marijuana
Sleeping pills
Tranquillisers
Antidepressants
Painkillers
Stimulants (such as Ritalin)
Cocaine or other stimulant drugs
Heroin
Ecstasy (MDMA)
Other
Now, take the first substance you ticked and ask yourself this simple question: How would you feel if you quit this substance completely for the next fortnight?
If you wouldn’t be able to quit we could say that you are addicted. Another definition of addiction is that you continue to use the substance despite it having harmful consequences – on yourself, your work or your relationships. If you could quit but you know you’d feel rough, we would say that you are dependent.
Now look at the list on page 16 and tick the appropriate column so that you have a record of your relationship with these potentially addictive substances. If, on the other hand, you have already quit one or all of these substances and still feel rough, with low energy, mood swings and a feeling of emptiness, tick the box labelled ‘still suffering’. What you tick is your baseline.
Dependent Addicted Still suffering
Caffeine
Sugar
Alcohol
Nicotine
Marijuana
Sleeping pills
Tranquillisers
Antidepressants
Painkillers
Stimulants (such as Ritalin)
Cocaine or other stimulant drugs
Heroin
Ecstasy
Other
Take a photocopy of this page and have a look at it again when you’ve completed our How to Quit Action Plan (as detailed in Part 4). We hope that there will be no more ticks in these boxes, if that’s what you want. The advice in this book will also help you recover your joie de vivre – a lack of which leads many towards using mind-altering substances in the first place.
Of course, we are not proposing that all of these substances must be avoided by everybody all the time. For most, the occasional coffee, sugary food or alcoholic drink is perfectly OK. Assuming you are not a recovering alcoholic, and if you can occasionally partake without triggering a need to do it over and over or gradually increase the amount you consume, good. If not, then an appropriate goal for you would be to abstain completely from the substance that is a problem for you.
A culture of addiction?
In Britain alone it is estimated that there are over 10 million smokers, and the same number of ex-smokers, whereas six and a half million people drink harmful levels of alcohol. In terms of serious consequences a person dies every month from ‘E’ pills and amphetamines; a person dies every day from heroin or methadone, every 20 minutes from alcohol and every four minutes from the consequences of smoking.
Not only is the use of these potentially addictive substances going up and up, especially in the Westernised countries, but so too is the amount we spend on them daily. Some of us spend as much on these substances as wd-a on food. Why?
The answer, most of the time, is that we think or hold on to the belief that they make us feel better – happier, less stressed, more energised, more ‘connected’, more relaxed or in less pain. The trouble is, the more you have, the more you need (that’s the first criterion of addiction: you become tolerant to its effects), and the more you need the worse you feel when you don’t have it (that’s the second criterion: withdrawal symptoms). Both tolerance and withdrawal happen because these substances change the way your brain’s chemistry works until you end up programmed for craving and addiction.
Why haven’t you quit?
The chances are you’ve tried to give up the substance or cut down many times. In the beginning you thought you could just do it with willpower but, despite having the motivation and will, after a few days or weeks, you were back where you started. Why?
Why, despite all your good intentions, did you start using the substance again when you’d decided to stop completely? It probably doesn’t even make sense to you that if your feel-good substance is no longer giving you the same pleasure it used to, or if it is creating some kind of problems in your life, you choose to keep using it or keep going back to it.
The answer is simple, and one of the main messages of this book:
When you quit, you experience what we call ‘abstinence symptoms’, which may be more difficult for you to tolerate than the problems that result from continuing or going back to your substance of choice.
The other important message of this book is that there is a way out – it is possible to quit and not feel s**t.
Someone may have told you that you might feel lousy for a few days, but then you would feel better. But that didn’t happen for you. And then, did your desire for the substance overpower your desire to quit? Do you feel a failure because you can’t do something you know you should? Despite your desire to quit, is there a niggling voice in your head that says you’ll never succeed? You’ll soon discover, as you continue to read, that what happens to you when you use a mood-altering substance and what happens when you don’t is a result of changes in your brain. The very nature of addictive substances, and the way they reprogramme the instinctive and emotional part of the brain, is a far stronger influence on your behaviour than your rational mind. Unless you reprogramme your brain’s chemistry away from dependency, quitting becomes difficult, if not impossible – and at the very least, certainly uncomfortable. Strong, instinctive and largely unconscious forces – sometimes as strong as the survival instinct itself – are at work to keep you consuming your feel-good substance. But once you understand the dynamics, and how to change them, it gives you power to control these seemingly irresistible cravings.
You are not alone
If you struggle to feel yo, or less bad, without a smoke, something sweet, something to drink, or some other substance, you are not alone. Addiction or dependence affects most of us at one level or another. The use of addictive substances, whether caffeine in tea and coffee, or alcohol and cigarettes, is part of everyday life for most of us. Most people are somewhere along the continuum from mildly dependent to seriously addicted.
Many of us use a combination of substances to change how we feel: sugar, alcohol, nicotine, caffeine or prescription drugs (to name the legal ones). We harshly judge the use of illegal drugs, such as cannabis, cocaine, amphetamines, heroin and Ecstasy, but your brain doesn’t care whether a substance is legal or not. All of these substances contribute to scrambling your brain’s chemistry.
The addiction epidemic
In Britain, despite all the campaigns, taxes and over 100,000 smoking-related deaths each year, one quarter of all adults smoke.1 We drink an average of 16 units of alcohol a week – that’s 4.5 litres (8 pints) of beer.2 A third of 16 to 24 year olds smoke and their average alcohol intake is 18 units a week – more than two bottles of wine. Collectively we drink 70 million cups of coffee every day – the equivalent of two each for adults.3 One-quarter of our water intake is from caffeinated tea.4 In one survey of over 5,000 people, the average caffeine intake per day was 241mg (a regular coffee or strong tea is about 100mg).5 Most of us are having at least three stimulant drinks a day. And some of us are drinking a few cups more to make up for those who don’t drink any.
An estimated 7.5 million people in the UK have used cannabis, and up to 2 million do so on a regular basis.6 One in ten of the UK population use one or more illicit drugs.7 In the UK the number using cocaine has doubled in the last five years to over 1 million people.8
In America 22 million people are classified with substance abuse or dependence problems.9 Seven million children in the US take stimulant drugs (usually for attention or hyperactivity problems) – that’s roughly one in five.10 In Britain 359,000 prescriptions were written out for just two (Ritalin and Concerta) in 2004.11 In the UK there’s an estimated 1.7 million tranquilliser addicts (that’s benzodiazepines alone) and 31 million antidepressant prescriptions written annually. The number of people addicted to them is unknown. Over 180,000 people seek addiction treatment each year.12
ESTIMATED NUMBER OF PEOPLE DEPENDENT/ADDICTED
(per cent of UK population)
Nicotine 15 million (25%)
Caffeine 12 million (20%)
Alcohol 4.6lion (8%)
Tranquillisers 1.5 million (2.5%)
Heroin 150,000 (0.25%)
Cocaine 20,000 (0.03%)
(Sources: Ash, Drug Scope, Alcohol Concern, Department of Health, NHS)
But am I addicted?
Addiction to any substance is a serious problem. Perhaps you think because you do not consume illegal drugs or are not an alcoholic that you are not addicted or that your heavy use of nicotine, caffeine or sugar is not a problem. The proof is in the pudding: if you’ve tried to kick the habit but ended up feeling so bad you start using the substance again, then you’re probably addicted. The longer you’re addicted the more your brain’s chemistry changes, the less effective the substance becomes and the stronger your desire grows to keep using it. It’s a vicious circle.
Abstinence symptoms: why quitting is so hard
As we have said, there are symptoms of addiction that occur while you are using a substance, but even more distressing for most people are those that occur when they stop using the substance. We have already explained a little about these symptoms and that we refer to them as abstinence symptoms. These can vary from mild to extremely severe, and they are the reason that most people fail to stick with their attempts to quit.
Acute withdrawal: symptoms when you first stop
The first symptoms that occur when you quit a substance are related to acute withdrawal, and in most cases are the opposite of the effects of the substance. For example, if you are using a substance that stimulates you, when you stop you will feel a lack of energy: lethargy, drowsiness, fatigue. If, on the other hand, you have been using a substance that relaxes you, when you stop you will probably feel a high level of agitation, anxiety and jitteriness. Some substances, like nicotine, do both, and quitting brings on a mixture of withdrawal effects. (If you have a severe addiction to a drug with relaxing effects – such as alcohol, a painkiller or an anti-anxiety drug – it may not be safe to stop taking it suddenly and we would strongly recommend that you get medical support.)
Most of the acute withdrawal symptoms will subside within three to ten days. And most people can make it through those, expecting that then the worst is over and they are in the clear. However, what happens next is that other symptoms will begin to emerge, lasting weeks, months or even years if you don’t know what to do to reduce or eliminate them. Some of these may actually become worse over time. The most common ones are listed in our Scale of Abstinence Symptoms Severity on page 26. But before you look at it we will describe in some detail a few of the symptoms that tend to be the most baffling and distressing over time. In Part 2 we’ll show you how to quit without experiencing these symptoms.
Hypersensitivity: when everything is too much
One of the most common abstinence symptoms is hypersensitivity to everything. Put simply, you have heightened sensitivity to external and internal stimuli: noise, light, touch, pain and stress. People who experience this most intensely are unable to filter out background noises and happenings, and this causes them to feel bombarded by all that is going on around them. If you are troubled by this, you feel constantly overwhelmed by everything going on around you and by all your internal thoughts and feelings. What would usually be considered mild stress becomes major stress. Sounds that others do not notice become major distractions for you. Pain is more intense, and simply being touched can even sometimes feel like being mauled. People who are the most troubled by this feel overwhelmed by a world that comes at them full force.
In most cases this particular symptom is partly genetic. Alcoholics, children of alcoholics and those with attention deficit hyperactivity disorder (ADHD) have been found to ‘magnify perceptual input’ (magnify everything their senses experience) and this has been associated with craving for a mood-altering substance.13 It commonly exists prior to using an addictive substance and probably contributes to the risk that someone will use mood-altering substances at an early age. For some, certain substances, including alcohol, make this symptom disappear. So it would be expected that people plagued by it from childhood would use a substance that offers relief and that they would experience it again when they quit.
You find it difficult to concentrate
Although the inability to concentrate can result from any number of brain disturbances when you quit a substance, it can also be, and often is, related to hypersensitivity. When the buzzing of a fly demands as much attention as the person talking to you, it is difficult to stay focused on what that person is saying. It’s not rudeness and it’s not intentional. It is just very difficult to maintain a focus when everything around you is calling to you at the same time. It can be frustrating and embarrassing to realise that someone is talking to you but you haven’t taken it in.
Your memory becomes poor
Problems with memory result from the inability to concentrate. If you didn’t take in what someone said to you or were distracted when it occurred, you won’t remember it. Or the memory will be sketchy. You can’t recall what was never really recorded in your brain in the first place. Memory problems can also be related to fuzzy thinking, which often occurs when neurotransmitters in the brain are not communicating properly (we explain how neurotransmitters work in Chapter 2). It is hard to remember what you haven’t grasped in the first place.
Your mood changes
You may experience anxiety, depression or both as a result of quitting. A certain amount of psychological stress is expected when change is going on. Change is stressful, and it is normal to have some fear connected with quitting your feel-good substance. But stress is exacerbated to the point of anxiety by hypersensitivity and the inability to concentrate and remember.
Maybe what you feel is not what you would really call depression, but is just a general feeling of discomfort or unpleasantness, an inability to feel pleasure. You feel that the colour has gone out of life. Sometimes these feelings come and go and take the form of mood swings. One day you feel good and then soon feel very ‘down’. The tendency is to believe when you’re feeling good that you are always going to feel good; it’s then disheartening when you are again overcome by the inability to feel pleasure.
You crave substances to change your mood
Intense cravings, or what some refer to as ‘drug hunger’, is a powerful compulsion to alter one’s mood with a substance. The abstinent person experiencing cravings knows what will bring relief. Hypersensitivity has been linked to a strong craving for alcohol, drugs and sweets. And alcohol, drugs and sweets normalise it. Feeling incomplete or inadequate or unfulfilled is common with abstinence from any substance that you have used to satisfy you. You experience a feeling of emptiness and a yearning for something, anything, to fill up the emptiness.
You have trouble sleeping
Many people experience sleep problems when they quit addictive substances. A common problem for abstinent alcoholics in early recovery, for example, is unusual or disturbing dreams. This is probably because alcohol suppresses REM sleep. This is the stage of sleep when we dream. And when we miss REM sleep our body tries to make up for it when we do begin to get dream sleep. The same is true with cannabis. This results in a rebound effect and we dream more than normal.
People who quit using other substances have other problems, such as having trouble getting to sleep and/or staying asleep. If this happens to you, you will probably feel sleepy in the daytime or feel tired all the time. Some people experience a difference in their sleep patterns, sleeping for long periods of time or sleeping at different times of the day.
The most serious sleep problems are associated with withdrawal from sleeping pills or benzodiazepines (like Valium and especially Xanex or Klonopin).
CAUTION It is dangerous to come off these drugs suddenly; you should taper off gradually. If you withdraw too rapidly, you may go for long periods without sleeping at all or worse, slip into a coma and die. For this reason we strongly recommend that you seek experienced medical help when tapering off any benzodiazepine.
Record your symptoms to monitor your recovery
Take a look at the Scale of Abstinence Symptoms Severity on the following pages. These are the most common symptoms that people experience when they quit and their brain chemistry is still in dependency mode. Even if you quit something months or even years ago your brain may still be out of balance and you may continue to experience some of these symptoms. Of course, not everyone who quits suffers from all these symptoms. What symptoms you have and how severe they are depends partly on what drug you have used and partly on your own biochemistry. Although we talk about these as ‘abstinence’ symptoms, sometimes it’s these kinds of symptoms that lead you to use a substance in the first place to provide relief. Your brain chemistry can lilly be out of balance from birth.
Here are some guidelines for getting and evaluating your abstinence severity score:
1. Use the scale to find your score when you have quit, because if you are still using your feel-good substance, your score will not give you the correct picture. This is because the substance is changing how you feel. The question is how you feel when you are not using it. So, use the checklist to determine your score after you have not used your substance(s) for at least one day.
2. If you are going through a medical detox for alcohol or other drug withdrawal, find your score when you are through the acute withdrawal phase.
3. Circle the number that best indicates the severity of each symptom you are experiencing today while you are no longer using your mood-altering substance.
SCALE OF ABSTINENCE SYMPTOMS SEVERITY
Circle the number that best indicates the severity of each symptom you are experiencing today (zero indicates the absence of the symptom, 10 represents an extreme, intolerable intensity level). Answer each question as honestly as possible.
Low level High level
Craving or drug hunger 0 1 2 3 4 5 6 7 8 9 10
Craving for sweets/sugar/bread 0 1 2 3 4 5 6 7 8 9 10
Craving for salt 0 1 2 3 4 5 6 7 8 9 10
Loss of appetite 0 1 2 3 4 5 6 7 8 9 10
Overeating/always hungry 0 1 2 3 4 5 6 7 8 9 10
Bloating or sleepiness after eating 0 1 2 3 4 5 6 7 8 9 10
Sense of emptiness/incompleteness 0 1 2 3 4 5 6 7 8 9 10
Anxiety 0 1 2 3 4 5 6 7 8 9 10
Internal shakiness 0 1 2 3 4 5 6 7 8 9 10
Restlessness 0 1 2 3 4 5 6 7 8 9 10
Impulsiveness/acting before thinking 0 1 2 3 4 5 6 7 8 9 10
Difficulty concentrating/focusing 0 1 2 3 4 5 6 7 8 9 10
Fuzzy thinking/head cloudy/ brain fog 0 1 2 3 4 5 6 7 8 9 10
Memory problems/memory loss 0 1 2 3 4 5 6 7 8 9 10
Depression 0 1 2 3 4 5 6 7 8 9 10
Mood swings 0 1 2 3 4 5 6 7 8 9 10
Negative self-talk 0 1 2 3 4 5 6 7 8 9 10
Irritability/impatience with people 0 1 2 3 4 5 6 7 8 9 10
Daytime sleepiness/drowsiness/ dozing off 0 1 2 3 4 5 6 8 9 10
Problems getting to or staying asleep 0 1 2 3 4 5 6 7 8 9 10
Fatigue/lack of energy/worn out 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to stress 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to sound or noise 0 1 2 3 4 5 6 7 8 9 10
Hypersensitivity to pain 0 1 2 3 4 5 6 7 8 9 10
Dry mouth/dry eyes/dry skin 0 1 2 3 4 5 6 7 8 9 10
Aches/muscle or joint pain/ headaches 0 1 2 3 4 5 6 7 8 9 10
Add up your total score:
When did you first experience the symptoms?
Although we call these ‘abstinence symptoms’, you may have had some of them before you got hooked. Perhaps the substance you became addicted to was the one that worked best to relieve those symptoms. In other words, the symptoms can be the reason you began using the substance in the first place, or they can be the consequence of substance overuse. Which way is it for you? If it is that the symptoms existed before and you used a feel-good substance to relieve them, then they will return even more intensely when you stop using that substance, depending on the degree of damage to your nervous system caused by the substance.
Whether the symptoms are cause or effect, if you have quite a few of these symptoms when you attempt to clean up your act, it’s time to do something about it. If you are still unsure whether or not you are ready, ask yourself this:
Would you be ready to quit if you knew you didn’t have to go through the discomfort you experienced when you tried to quit in the past?
See how your symptoms improve
Most people who follow our programme cut their abstinence symptom score by at least a third within one week, and by a half to three-quarters within four weeks simply by tuning up their brain chemistry with our How to Quit programme. And that’s the big secret to quitting successfully: creating a level of health and a state of mind free from craving and discomfort.
Are you still unsure if you are really addicted?
Many people tell us that they consume substances on a regular basis, get great joy or satisfaction from doing so, and therefore can’t be addicted or dependent. Well, that would depend upon your definition of addiction. As we have been pointing out, addiction is not just about what happens when you use a substance, but what happens when you don’t. When we talk about addiction or dependency in this book we are talking about a condition in which there is a compulsion to keep using a substance despite negative consequences, as well as withdrawal symptoms when regular use ceases.
Of course, you can have negative consequences with or without compulsive use and withdrawal symptoms. The substances we are focusing on are harmful in a number of ways even if we are not addicted to them. Many people who are not addicted drink more than they should and may sometimes drink irresponsibly. Caffeine and sugar in excess are not good for us whether or not we are addicted. The big question is whether or not you can easily give them up when it becomes apparent that it is wise to do so.
Case study SARAH AND KENNY
Let’s take two people who enjoy sweets and eat them on a regular basis. They both begin to gain weight and to have some health problems. They both decide to lose weight. Sarah, who is not addicted, is able to reduce or perhaps eliminate sweets from her diet. She loses weight and enjoys the accomplishment of controlling the amount of sugar she consumes. Kenny stops eating sweets only briefly before going back again and again to the same pattern of eating. He gradually increases the amount he eats and ultimately develops diabetes. Despite his weight and physical problems he is unable to control his sugar intake. He is addicted to sugar.
Most people feel tired and stressed as a consequence of too much sugar, caffeine, alcohol or cigarettes. Yet the addicted brain says ‘have a coffee/have a drink/have something sweet/have a cigarette – it will make you feel good.’ If you recognise that these substances are harming you and you can make the choice to stop using them without craving and discomfort – or if you are able to limit them to occasional use (not likely in the case of cigarettes) – you are probably not addicted. But if you continue to consume the substance despite ongoing negative consequences, and if you feel lousy when you quit, you are addicted and need to do something about it.
You can let go
If you are ready to quit, we have a How to Quit programme to help you. In most cases this takes 12 weeks to complete – defined as being free from abstinence symptoms. We will show you how to free yourself from the hold your substance of choice has on you. If you are not sure whether you are ready to give it up, come along with us. Find out what can happen if you choose to quit. We will show you that it really is possible to quit without feeling s**t, with this amazingly successful, scientifically based programme.
SUMMARY
If you are dependent on a substance – caffeine, sugar, nicotine, alcohol, or prescription or illicit drugs – you are not alone. Most of us have some type of dependency.
You may have given up using the substance you are dependent on but suffer from a variety of symptoms we call abstinence symptoms – listed in the Scale of Abstinence Symptoms Severity.
You may have had some of your symptoms before you started using an addictive substance and then found that the substance relieved them.
Whether the symptoms are a cause or a result of using the substance, if you have a number of them, or if the ones you have are very severe, you can do something about them.
The How to Quit programme we describe in Part 4 will help free you from the discomfort of abstinence and prevent you returning to addictive use
Thursday 8 May 2014
The prescription drugs not the answer
Some of the most widely prescribed drugs are antidepressants, tranquillisers, sleeping pills and stimulant drugs. You might have been prescribed these drugs because you were feeling depressed, anxious or unable to sleep – and then became addicted to them. Or you might have started taking these drugs to help you deal with the withdrawal effects associated with coming off another addictive substance. But using an addictive substance to relieve the pain of getting off an addictive substance is not the ansr.
It is true that when most people give up using a feel-good substance because it is creating problems for them, they quickly find another substance to relieve the discomfort of abstinence. When alcoholics stop drinking they increase their intake of nicotine, caffeine and sugar. People who give up smoking frequently relieve their stress by eating – usually junk food. In order to control their weight, some sugar addicts take up smoking. Some marijuana users start drinking or increase their alcohol consumption.
Switching one addictive substance for another is not the answer; it is part of the problem. Swapping one drug for another doesn’t unscramble your brain.
The rise of prescription drugs
In recent years, medical professionals have become part of this problem: by prescribing prescription drugs to relieve the pain of abstinence symptoms. Of course they are not aware that this is what they are doing. They believe they are prescribing drugs for depression, or anxiety, or sleeplessness or lack of energy. And frequently the outcome for the patient is trading one addiction for another. Most of these prescribed drugs are addictive, sometimes more so than the original addictive substance.
While these drug approaches may be a short-term stepping stone to staying clean or sober, the need for alternative stimulants or relaxants is a sure sign that your brain chemistry is still out of balance. Substituting one drug for another doesn’t correct the underlying imbalance. Until this fundamental factor is addressed, any approach to quitting any addictive substance, from cigarettes to cocaine, becomes several times harder.
The main point of giving these prescription drugs is to minimise, in the short term, abstinence symptoms. However, as you will see, if these abstinence symptoms can be more effectively reduced by our nutritional approach (using nutrients and amino acids), the need for substitute medications, with their own withdrawal effects, becomes unnecessary, thus removing this curious paradox: using a drug to correct a biochemical imbalance in the brain caused by using a drug.
How mental-health conditions are diagnosed
You might think that a scientific approach would be to check whether a person actually has a biochemical imbalance, and, if so, exactly which neurotransmitters (see Chapter 2) were low. The correct amino acids or other nutrients could then be prescribed to help restore the brain’s chemical balance. But that is not what happens. Instead, the diagnosis of almost all mental-health conditions, addiction being one, is based solely on a checklist of symptoms that doesn’t tell you anything about what is going on with the brain or its chemistry.
Checking neurotransmitter balance
At the Brain Bio Centre, our outpatient treatment centre, one of the first things we check for in anyone experiencing problems with depression, anxiety or sleep is the balance of neurotransmitters. We do this based on the tests first developed by ProfessTapan Audhya, from New York University Medical Center, who found very low levels of serotonin in the blood of depressed patients.37 Noradrenalin levels are also often low in those with depression.
Knowing that this neurotransmitter is made directly from amino acids found in food, Audhya then gave his patients 5-hydroxytryptophan (5-HTP), the amino acid that’s a direct precursor to serotonin. This corrected the deficiency and resulted in major and rapid relief from depression.
The usual route with prescribing
We’re sure you would agree that the above is a logical approach: to identify the imbalance, then provide the brain with the nutrients necessary to allow it to rebalance. But this is not what happens in most medical practices or recovery centres. When the abstinence symptoms (depression, anxiety, insomnia) are severe, many people are given more drugs (antidepressants, tranquillisers and sleeping pills) that compound the problem. Many addicts then get hooked on these. Heroin addicts are given methadone, and then get hooked on that. For many, it’s harder to get off methadone than heroin, and incredibly difficult to get off certain tranquillisers and antidepressants.
In our experience, some of the new drugs on the market, which were launched on the premise that they were less addictive or had fewer side effects, have proven to be just as bad, if not worse. Let’s take a look at these, starting with antidepressants.
Are you addicted to antidepressants?
Depression is an extremely common symptom in those with addiction problems, especially among alcoholics, both while drinking and when sober. One in six people in Britain between the ages of 25 and 44 suffers from depression, according to a report by the Royal College of Psychiatrists.38 If you are, or have been, one of these people, the chances are you will have been offered antidepressant drugs. If you’ve taken them, the chances are you’ll have a hard time getting off them, especially if you are taking one of the more recent generations of drugs.
Understanding antidepressants
Back in the 1980s the most prescribed drugs were called ‘tricyclic’ antidepressants, the most popular being amitriptyline. In the 1990s these were largely replaced by a new class of drug (with new patents affording them higher prices) called SSRI (which stands for selective serotonin reuptake inhibitor) antidepressants, with names like Prozac, Seroxat and Lustral, and SNRI (which stands for serotonin and noradrenalin reuptake inhibitor) antidepressants, like Cymbalta and Efexor. The marketing of these drugs suggested they were safer and more effective. The so-called ‘cessation effects’ (symptoms experienced when you stop taking the drugs) were downplayed until, in 2003, the Medicines and Healthcare Products Regulatory Agency (MHRA) said that these should be called ‘withdrawal’ effects. (In the US, these are euphemistically called ‘discontinuation’ effects.) SSRIs and SNRIs have largely replaced tricyclic antidepressants, although a review of the research in 2005 noted that most studies show little difference in effectiveness.39
SSRIs and SNRIs are more ‘selective’ in the sense that, in the case of SSRIs they only target the enzyme that clears away serotonin, the key mood neurotransmitter; and in the case of SNRIs, they target enzymes that clear both serotonin and noradrenalin. Their major advantage was supposed to be fewer side effects, and it is not as easy to overdose on them as on tricyclics. The most commonly prescribed SSRIs are fluoxetine (Prozac), paroxetine (Seroxat) and sertraline (Lustral, Zoloft); and the most commonly prescribed SNRIs include venlafaxine (Efexor) and duloxetine (Cymbalta). However, they appear, in some ways, to be more dangerous. We have heard of many patients who have failed to quit Efexor because the ‘discontinuation’ effects are so severe.
The side effects
The risk of suicide in both children and adults for many of these SSRIs is, at least, doubled. A major review in the British Medical Journal of 702 studies on SSRI antidepressants showed that people taking an SSRI were more than twice as likely to attempt suicide compared with those taking a dummy pill.40 The researchers also noted that the actual number of suicide attempts is likely to be much higher, because many of the studies did not gather information on suicide. SSRIs can also cause patients to feel ‘fuzzy’ and can cause major sexual dysfunction, resulting in an inability to climax in both men and women. This can prevent the intimacy that might help someone come through depression and addiction. On top of this, research published in 2006 suggests that SSRIs might dramatically increase the risk of death in those with cardiovascular disease.41 Despite these risks, UK doctors wrote out 31 million prescriptions for antidepressants in 2006, at a cost of £291 million.
All these drugs have side effects, such as nausea, headaches, insomnia, sleepiness, dry mouth, dizziness, constipation, weakness, sweating, nervousness and sexual dysfunction. Many people also report memory loss with continued use. But most worrying are the withdrawal symptoms when you need or want to stop taking them. Consider the case of Nancy:
Case study NANCY
‘When I came to treatment 15 months ago I had been on Seroxat for ten years, clonazepan and Adderall for five years each, and smoking marijuana for ten years. Of all the drugs I was coming off, the antidepressant Seroxat had by far the worst withdrawal problems. I had been taking it for so long that my body did not know what to do without it. I experienced severe withdrawal effects such as panic attacks, the feeling of crawling out of my skin, brain zaps, nausea, dizziness and restlessness, as well as uncontrollable emotions (laughter and crying). I tried to stop taking it all at once and my body could not handle it, so Dr Braly and I decided I would taper slowly off it. The thing that helped me the most was taking the amino acids GABA and tryptophan during the day as needed to ease my anxiety and panic.
‘I truly believe that your approach to treating addiction disease is the best out there. I definitely feel that I would not have been able to successfully come off drugs had I not gone through this programme. I’m extremely grateful to have come off the drugs I was on and especially to have given up Seroxatbeefeel great today and I know it’s a result of the treatment I had and my continuing to eat the right foods and take supplements (especially eating fish and taking fish oil supplements), as well as exercising.’
Taking it slowly
In our experience, supported by scientific literature, antidepressants like Seroxat and Efexor are very difficult to come off. It is essential to taper off these drugs slowly, over at least three months, but, for some people, withdrawal symptoms continue for much longer.42 The organisation CITA (see Resources page 484 for details) gives precise, day-by-day, withdrawal charts for all antidepressants and tranquillisers. If you are on an antidepressant and have tried and failed to come off, Chapter 24 explains how to minimise withdrawal symptoms if you want to quit. But don’t try to get off an antidepressant suddenly and do not make any changes in your antidepressant medication without consulting and cooperating with your, hopefully, nutritionally informed doctor.
If you are taking more than one prescription drug it is very important to withdraw them one at a time, with a gap of ideally three months between them.
Benzos, the Zs and the frying pan
If you’ve been consuming large amounts of stimulants – caffeine, nicotine, amphetamines or cocaine – and you stop, it’s often hard to stay awake when you’re awake or asleep when you’re asleep. You might find yourself drinking more alcohol to help you relax and sleep. When you stop drinking you find it hard to switch off the anxiety and go to sleep. As a consequence you may have either been prescribed some kind of sleeping pill or tranquilliser. You are not alone. In the UK over 16 million prescriptions for what are called hypnotic (sleeping) and anxiolytic (anxiety-reducing) drugs were written out in 2004, at a cost of £37 million.
Remember the Rolling Stones’ song ‘Mother’s Little Helper’? Back in the 1960s the new miracle drugs for curing anxiety and insomnia were the benzodiazepines (the Little Helper’ referred to in the song), said to be safer and less addictive than their predecessor, the ‘non-addictive’ meprobamate (Miltown), which was later shown to be as addictive as the old drugs it had replaced. We now know that the replacement ‘benzo’ drugs are among the most addictive, and hard to get off, substances – for many people, harder than heroin.
The benzos
Benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), clonazepam (Klonopin) and then the shorter-acting alprazolam (Xanax), lorazepam (Ativan) and temazepam. In the UK, 16 million prescriptions are still written annually for these so-called ‘minor tranquillisers’ to treat anxiety, insomnia, seizures and muscle spasms. Their calming effect is due to their action on GABA: by increasing GABA receptors, the most common receptors in the brain. The benzodiazepines dull both awareness and overall brain activity. However, they also have turned out to be nearly as addictive as what they replaced. Addiction to Xanax has been reported to occur in some people in as little as three days. And, in our experience, benzodiazepines may be the most difficult drugs to withdraw from, sometimes taking months.
CAUTION You should never stop taking benzodiazepines suddenly. It is dangerous. Give yourself plenty of time to taper them off gradually.
The Zs
Then (as the patents and consequently the profits run out) along come the Zs, with names such as zolpidem (Ambien), zaleplon (Sonata) and zopiclone (Zimovane). They were introduced in the 1990s amid claims that they were a safe and non-addictive alternative to earlier drugs. Guess what? They too are every bit as addictive.
A major review in 2005 by the National Institute for Clinical Excellence (NICE) concluded that ‘there was no consistent difference between the two types of drug [benzodiazepines and Zs] for either effectiveness or safety.’43 They too can cause tolerance and withdrawal. Dependence can develop after as little as one week of continuous use. Similarly, you are also advised not to take nonbenzodiazepines for more than a few weeks at most. A bulletin regarding the drug zopiclone advises:
This medicine is generally only suitable for short-term use. If it is used for long periods or in high doses, tolerance to and dependence upon the medicine may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. For this reason, treatment with this medicine should usually be stopped gradually, following the instructions given by your doctor, in order to avoid withdrawal symptoms such as rebound insomnia or anxiety, confusion, sweating, tremor, loss of appetite, irritability or convulsions.44
But these are the sleeping pills you are more likely to be offered on prescription these days, especially if you can’t sleep because you’ve stopped smoking or drinking or you have come off a stimulant drug. In 2004, there were close to 4 million prescriptions made for Zimovane (zopiclone) in the UK alone. They will certainly help if you have a short-term problem with sleeping due to a crisis, but in the long term they are not what’s needed. ‘If you have chronic insomnia,’ says Professor Jim Horne of Lough-borough University’s Sleep Research Centre, ‘it’s because you have an underlying problem and just getting an extra half an hour’s sleep, which is about all the drugs give you, is not going to help tackle it.’
Nutrition can create an escape route
Both benzodiazepines and the Zs can be very difficult to come off, and near impossible without the nutritional support we recommend in Chapter 23. In that chapter you’ll find the story of Pauline, who was hooked on Zimovane: ‘I tried so many times to come off it and failed. Once I didn’t have any for three days, couldn’t sleep and drove into the back of a car!’ Pauline finally got free using our nutrition-based approach. ‘To this day I still take these nutrients and I feel great. Goodbye Zimovane!’
We don’t recommend zepines and the Zs, except for very short-term use. It’s a case of out of the frying pan into the fire. Of course, there are newer drugs now on offer, which are claimed to be non-addictive, although this remains to be seen. First in the ring was eszopiclone (Lunesta), licensed in 2005 for long-term use after studies apparently showed no addiction and no need for an increased dose after six months. It is a variation on zopiclone and is little different in effect. In controlled trials, this drug increased the amount of sleep time by between 15 and 21.5 minutes, compared to a placebo. So why risk potential addiction for so little benefit? In the US you can barely turn on the television without seeing ads for drugs such as these vying for the market of an estimated 1.7 million benzo addicts and probably just as many Z addicts. We don’t recommend you join them. If you have already, or you are tempted to because of abstinence symptoms from other substances, the 12 Keys to Unaddicting Your Brain in Part 2 will dramatically reduce your need. If you have already developed a dependency, also read Chapter 23 to find out the most effective ways to get off these drugs.
Methadone madness
Finally, a word on methadone. Many treatment approaches for heroin addiction involve replacing the heroin with methadone, a similar drug that can be, and is, prescribed to the hundreds of thousands of methadone addicts in the UK alone. If your thinking is that heroin addiction is ‘incurable’ and your goal is to keep an addict away from crime and dodgy needles, then switching to a prescribable, controllable substance may sound like a good thing. But if the ultimate goal is to get clean, methadone is not the answer. A methadone user is still addicted. And methadone is usually harder to get off than heroin. Neither the quadrupling of methadone prescriptions in Britain between 1982 and 1992, nor the doubling of them in the US between 1999 and 2001, has had any effect on the scale of the problem of opiate addiction. Many addicts become addicted to both heroin and methadone. Substantial numbers of people are killed by methadone. Between 1993 and 2004 there were 7,072 deaths involving heroin or morphine and 3,298 deaths involving methadone.45 Currently, about 1.5 million prescriptions for methadone are written every year.46 Some doctors recommend switching to other opioid drugs such as buphenorphine, but these carry the same kind, although possibly not the same scale, of risks.47
In Chapter 27 we look at the most effective ways to get off heroin or methadone or any opioid drug for good.
None of these drugs correct the underlying imbalances that lead to addiction and dependence even though they can temporarily relieve the abstinence symptoms. Even if they do get you out of the fire, you’re still in the frying pan.
The way forward
In the next part we explain the 12 Keys to UnaddictingYour Brain, many of which, on their own, have already been shown to be more effective than prescription drugs and, in combination, are substantially more effective without any of the associated risks of addiction and side effects. There is also nothing to stop you doing these keys to recovery while you are still on a prescription drug. And as you start to feel better, duss with your doctor gradually tapering off the drug as it becomes increasingly unnecessary. How to do this is explained for each kind of drug in Part 3.
SUMMARY
Drugs prescribed for depression, anxiety and sleeplessness are usually highly addictive.
These drugs are often prescribed when people are experiencing abstinence symptoms.
Swapping one addictive drug for another – even if prescribed by a doctor – is not an answer.
It is very important to taper off any prescription drug under the supervision of a doctor.
You can begin using the keys to unaddicting your brain listed in the next section while you are tapering off prescription drugs
It is true that when most people give up using a feel-good substance because it is creating problems for them, they quickly find another substance to relieve the discomfort of abstinence. When alcoholics stop drinking they increase their intake of nicotine, caffeine and sugar. People who give up smoking frequently relieve their stress by eating – usually junk food. In order to control their weight, some sugar addicts take up smoking. Some marijuana users start drinking or increase their alcohol consumption.
Switching one addictive substance for another is not the answer; it is part of the problem. Swapping one drug for another doesn’t unscramble your brain.
The rise of prescription drugs
In recent years, medical professionals have become part of this problem: by prescribing prescription drugs to relieve the pain of abstinence symptoms. Of course they are not aware that this is what they are doing. They believe they are prescribing drugs for depression, or anxiety, or sleeplessness or lack of energy. And frequently the outcome for the patient is trading one addiction for another. Most of these prescribed drugs are addictive, sometimes more so than the original addictive substance.
While these drug approaches may be a short-term stepping stone to staying clean or sober, the need for alternative stimulants or relaxants is a sure sign that your brain chemistry is still out of balance. Substituting one drug for another doesn’t correct the underlying imbalance. Until this fundamental factor is addressed, any approach to quitting any addictive substance, from cigarettes to cocaine, becomes several times harder.
The main point of giving these prescription drugs is to minimise, in the short term, abstinence symptoms. However, as you will see, if these abstinence symptoms can be more effectively reduced by our nutritional approach (using nutrients and amino acids), the need for substitute medications, with their own withdrawal effects, becomes unnecessary, thus removing this curious paradox: using a drug to correct a biochemical imbalance in the brain caused by using a drug.
How mental-health conditions are diagnosed
You might think that a scientific approach would be to check whether a person actually has a biochemical imbalance, and, if so, exactly which neurotransmitters (see Chapter 2) were low. The correct amino acids or other nutrients could then be prescribed to help restore the brain’s chemical balance. But that is not what happens. Instead, the diagnosis of almost all mental-health conditions, addiction being one, is based solely on a checklist of symptoms that doesn’t tell you anything about what is going on with the brain or its chemistry.
Checking neurotransmitter balance
At the Brain Bio Centre, our outpatient treatment centre, one of the first things we check for in anyone experiencing problems with depression, anxiety or sleep is the balance of neurotransmitters. We do this based on the tests first developed by ProfessTapan Audhya, from New York University Medical Center, who found very low levels of serotonin in the blood of depressed patients.37 Noradrenalin levels are also often low in those with depression.
Knowing that this neurotransmitter is made directly from amino acids found in food, Audhya then gave his patients 5-hydroxytryptophan (5-HTP), the amino acid that’s a direct precursor to serotonin. This corrected the deficiency and resulted in major and rapid relief from depression.
The usual route with prescribing
We’re sure you would agree that the above is a logical approach: to identify the imbalance, then provide the brain with the nutrients necessary to allow it to rebalance. But this is not what happens in most medical practices or recovery centres. When the abstinence symptoms (depression, anxiety, insomnia) are severe, many people are given more drugs (antidepressants, tranquillisers and sleeping pills) that compound the problem. Many addicts then get hooked on these. Heroin addicts are given methadone, and then get hooked on that. For many, it’s harder to get off methadone than heroin, and incredibly difficult to get off certain tranquillisers and antidepressants.
In our experience, some of the new drugs on the market, which were launched on the premise that they were less addictive or had fewer side effects, have proven to be just as bad, if not worse. Let’s take a look at these, starting with antidepressants.
Are you addicted to antidepressants?
Depression is an extremely common symptom in those with addiction problems, especially among alcoholics, both while drinking and when sober. One in six people in Britain between the ages of 25 and 44 suffers from depression, according to a report by the Royal College of Psychiatrists.38 If you are, or have been, one of these people, the chances are you will have been offered antidepressant drugs. If you’ve taken them, the chances are you’ll have a hard time getting off them, especially if you are taking one of the more recent generations of drugs.
Understanding antidepressants
Back in the 1980s the most prescribed drugs were called ‘tricyclic’ antidepressants, the most popular being amitriptyline. In the 1990s these were largely replaced by a new class of drug (with new patents affording them higher prices) called SSRI (which stands for selective serotonin reuptake inhibitor) antidepressants, with names like Prozac, Seroxat and Lustral, and SNRI (which stands for serotonin and noradrenalin reuptake inhibitor) antidepressants, like Cymbalta and Efexor. The marketing of these drugs suggested they were safer and more effective. The so-called ‘cessation effects’ (symptoms experienced when you stop taking the drugs) were downplayed until, in 2003, the Medicines and Healthcare Products Regulatory Agency (MHRA) said that these should be called ‘withdrawal’ effects. (In the US, these are euphemistically called ‘discontinuation’ effects.) SSRIs and SNRIs have largely replaced tricyclic antidepressants, although a review of the research in 2005 noted that most studies show little difference in effectiveness.39
SSRIs and SNRIs are more ‘selective’ in the sense that, in the case of SSRIs they only target the enzyme that clears away serotonin, the key mood neurotransmitter; and in the case of SNRIs, they target enzymes that clear both serotonin and noradrenalin. Their major advantage was supposed to be fewer side effects, and it is not as easy to overdose on them as on tricyclics. The most commonly prescribed SSRIs are fluoxetine (Prozac), paroxetine (Seroxat) and sertraline (Lustral, Zoloft); and the most commonly prescribed SNRIs include venlafaxine (Efexor) and duloxetine (Cymbalta). However, they appear, in some ways, to be more dangerous. We have heard of many patients who have failed to quit Efexor because the ‘discontinuation’ effects are so severe.
The side effects
The risk of suicide in both children and adults for many of these SSRIs is, at least, doubled. A major review in the British Medical Journal of 702 studies on SSRI antidepressants showed that people taking an SSRI were more than twice as likely to attempt suicide compared with those taking a dummy pill.40 The researchers also noted that the actual number of suicide attempts is likely to be much higher, because many of the studies did not gather information on suicide. SSRIs can also cause patients to feel ‘fuzzy’ and can cause major sexual dysfunction, resulting in an inability to climax in both men and women. This can prevent the intimacy that might help someone come through depression and addiction. On top of this, research published in 2006 suggests that SSRIs might dramatically increase the risk of death in those with cardiovascular disease.41 Despite these risks, UK doctors wrote out 31 million prescriptions for antidepressants in 2006, at a cost of £291 million.
All these drugs have side effects, such as nausea, headaches, insomnia, sleepiness, dry mouth, dizziness, constipation, weakness, sweating, nervousness and sexual dysfunction. Many people also report memory loss with continued use. But most worrying are the withdrawal symptoms when you need or want to stop taking them. Consider the case of Nancy:
Case study NANCY
‘When I came to treatment 15 months ago I had been on Seroxat for ten years, clonazepan and Adderall for five years each, and smoking marijuana for ten years. Of all the drugs I was coming off, the antidepressant Seroxat had by far the worst withdrawal problems. I had been taking it for so long that my body did not know what to do without it. I experienced severe withdrawal effects such as panic attacks, the feeling of crawling out of my skin, brain zaps, nausea, dizziness and restlessness, as well as uncontrollable emotions (laughter and crying). I tried to stop taking it all at once and my body could not handle it, so Dr Braly and I decided I would taper slowly off it. The thing that helped me the most was taking the amino acids GABA and tryptophan during the day as needed to ease my anxiety and panic.
‘I truly believe that your approach to treating addiction disease is the best out there. I definitely feel that I would not have been able to successfully come off drugs had I not gone through this programme. I’m extremely grateful to have come off the drugs I was on and especially to have given up Seroxatbeefeel great today and I know it’s a result of the treatment I had and my continuing to eat the right foods and take supplements (especially eating fish and taking fish oil supplements), as well as exercising.’
Taking it slowly
In our experience, supported by scientific literature, antidepressants like Seroxat and Efexor are very difficult to come off. It is essential to taper off these drugs slowly, over at least three months, but, for some people, withdrawal symptoms continue for much longer.42 The organisation CITA (see Resources page 484 for details) gives precise, day-by-day, withdrawal charts for all antidepressants and tranquillisers. If you are on an antidepressant and have tried and failed to come off, Chapter 24 explains how to minimise withdrawal symptoms if you want to quit. But don’t try to get off an antidepressant suddenly and do not make any changes in your antidepressant medication without consulting and cooperating with your, hopefully, nutritionally informed doctor.
If you are taking more than one prescription drug it is very important to withdraw them one at a time, with a gap of ideally three months between them.
Benzos, the Zs and the frying pan
If you’ve been consuming large amounts of stimulants – caffeine, nicotine, amphetamines or cocaine – and you stop, it’s often hard to stay awake when you’re awake or asleep when you’re asleep. You might find yourself drinking more alcohol to help you relax and sleep. When you stop drinking you find it hard to switch off the anxiety and go to sleep. As a consequence you may have either been prescribed some kind of sleeping pill or tranquilliser. You are not alone. In the UK over 16 million prescriptions for what are called hypnotic (sleeping) and anxiolytic (anxiety-reducing) drugs were written out in 2004, at a cost of £37 million.
Remember the Rolling Stones’ song ‘Mother’s Little Helper’? Back in the 1960s the new miracle drugs for curing anxiety and insomnia were the benzodiazepines (the Little Helper’ referred to in the song), said to be safer and less addictive than their predecessor, the ‘non-addictive’ meprobamate (Miltown), which was later shown to be as addictive as the old drugs it had replaced. We now know that the replacement ‘benzo’ drugs are among the most addictive, and hard to get off, substances – for many people, harder than heroin.
The benzos
Benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), clonazepam (Klonopin) and then the shorter-acting alprazolam (Xanax), lorazepam (Ativan) and temazepam. In the UK, 16 million prescriptions are still written annually for these so-called ‘minor tranquillisers’ to treat anxiety, insomnia, seizures and muscle spasms. Their calming effect is due to their action on GABA: by increasing GABA receptors, the most common receptors in the brain. The benzodiazepines dull both awareness and overall brain activity. However, they also have turned out to be nearly as addictive as what they replaced. Addiction to Xanax has been reported to occur in some people in as little as three days. And, in our experience, benzodiazepines may be the most difficult drugs to withdraw from, sometimes taking months.
CAUTION You should never stop taking benzodiazepines suddenly. It is dangerous. Give yourself plenty of time to taper them off gradually.
The Zs
Then (as the patents and consequently the profits run out) along come the Zs, with names such as zolpidem (Ambien), zaleplon (Sonata) and zopiclone (Zimovane). They were introduced in the 1990s amid claims that they were a safe and non-addictive alternative to earlier drugs. Guess what? They too are every bit as addictive.
A major review in 2005 by the National Institute for Clinical Excellence (NICE) concluded that ‘there was no consistent difference between the two types of drug [benzodiazepines and Zs] for either effectiveness or safety.’43 They too can cause tolerance and withdrawal. Dependence can develop after as little as one week of continuous use. Similarly, you are also advised not to take nonbenzodiazepines for more than a few weeks at most. A bulletin regarding the drug zopiclone advises:
This medicine is generally only suitable for short-term use. If it is used for long periods or in high doses, tolerance to and dependence upon the medicine may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. For this reason, treatment with this medicine should usually be stopped gradually, following the instructions given by your doctor, in order to avoid withdrawal symptoms such as rebound insomnia or anxiety, confusion, sweating, tremor, loss of appetite, irritability or convulsions.44
But these are the sleeping pills you are more likely to be offered on prescription these days, especially if you can’t sleep because you’ve stopped smoking or drinking or you have come off a stimulant drug. In 2004, there were close to 4 million prescriptions made for Zimovane (zopiclone) in the UK alone. They will certainly help if you have a short-term problem with sleeping due to a crisis, but in the long term they are not what’s needed. ‘If you have chronic insomnia,’ says Professor Jim Horne of Lough-borough University’s Sleep Research Centre, ‘it’s because you have an underlying problem and just getting an extra half an hour’s sleep, which is about all the drugs give you, is not going to help tackle it.’
Nutrition can create an escape route
Both benzodiazepines and the Zs can be very difficult to come off, and near impossible without the nutritional support we recommend in Chapter 23. In that chapter you’ll find the story of Pauline, who was hooked on Zimovane: ‘I tried so many times to come off it and failed. Once I didn’t have any for three days, couldn’t sleep and drove into the back of a car!’ Pauline finally got free using our nutrition-based approach. ‘To this day I still take these nutrients and I feel great. Goodbye Zimovane!’
We don’t recommend zepines and the Zs, except for very short-term use. It’s a case of out of the frying pan into the fire. Of course, there are newer drugs now on offer, which are claimed to be non-addictive, although this remains to be seen. First in the ring was eszopiclone (Lunesta), licensed in 2005 for long-term use after studies apparently showed no addiction and no need for an increased dose after six months. It is a variation on zopiclone and is little different in effect. In controlled trials, this drug increased the amount of sleep time by between 15 and 21.5 minutes, compared to a placebo. So why risk potential addiction for so little benefit? In the US you can barely turn on the television without seeing ads for drugs such as these vying for the market of an estimated 1.7 million benzo addicts and probably just as many Z addicts. We don’t recommend you join them. If you have already, or you are tempted to because of abstinence symptoms from other substances, the 12 Keys to Unaddicting Your Brain in Part 2 will dramatically reduce your need. If you have already developed a dependency, also read Chapter 23 to find out the most effective ways to get off these drugs.
Methadone madness
Finally, a word on methadone. Many treatment approaches for heroin addiction involve replacing the heroin with methadone, a similar drug that can be, and is, prescribed to the hundreds of thousands of methadone addicts in the UK alone. If your thinking is that heroin addiction is ‘incurable’ and your goal is to keep an addict away from crime and dodgy needles, then switching to a prescribable, controllable substance may sound like a good thing. But if the ultimate goal is to get clean, methadone is not the answer. A methadone user is still addicted. And methadone is usually harder to get off than heroin. Neither the quadrupling of methadone prescriptions in Britain between 1982 and 1992, nor the doubling of them in the US between 1999 and 2001, has had any effect on the scale of the problem of opiate addiction. Many addicts become addicted to both heroin and methadone. Substantial numbers of people are killed by methadone. Between 1993 and 2004 there were 7,072 deaths involving heroin or morphine and 3,298 deaths involving methadone.45 Currently, about 1.5 million prescriptions for methadone are written every year.46 Some doctors recommend switching to other opioid drugs such as buphenorphine, but these carry the same kind, although possibly not the same scale, of risks.47
In Chapter 27 we look at the most effective ways to get off heroin or methadone or any opioid drug for good.
None of these drugs correct the underlying imbalances that lead to addiction and dependence even though they can temporarily relieve the abstinence symptoms. Even if they do get you out of the fire, you’re still in the frying pan.
The way forward
In the next part we explain the 12 Keys to UnaddictingYour Brain, many of which, on their own, have already been shown to be more effective than prescription drugs and, in combination, are substantially more effective without any of the associated risks of addiction and side effects. There is also nothing to stop you doing these keys to recovery while you are still on a prescription drug. And as you start to feel better, duss with your doctor gradually tapering off the drug as it becomes increasingly unnecessary. How to do this is explained for each kind of drug in Part 3.
SUMMARY
Drugs prescribed for depression, anxiety and sleeplessness are usually highly addictive.
These drugs are often prescribed when people are experiencing abstinence symptoms.
Swapping one addictive drug for another – even if prescribed by a doctor – is not an answer.
It is very important to taper off any prescription drug under the supervision of a doctor.
You can begin using the keys to unaddicting your brain listed in the next section while you are tapering off prescription drugs
Subscribe to:
Posts (Atom)