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