Wound Healing

Inflammatory Phase (Day 0-5)
The healing response is initiated at the moment of injury. Surgical or traumatic wounds disrupt the tissue architecture and cause haemorrhage. Initially, blood fills the wound defect and exposure of this blood to collagen in the wound leads to platelet degranulation and activation of Hageman factor [1]. This in turn sets into motion a number of biological amplification systems including the complement kinin and clotting cascades and plasmin generation. These serve to amplify the original injury signal and lead not only to clot formation, which unites the wound edges, but also to the accumulation of a number of mitogens and chemoattractants at the site of wounding [2].

Production of both kinins and prostaglandins leads to vasodilatation and increased small vessel permeability in the region of the wound [3]. This results in oedema in the area of the injury and is responsible for the pain and swelling which occurs early after injury. Within 6 h, circulating immune cells start to appear in the wound. Polymorphonuclear leucocytes (PMN) are the first blood leucocytes to enter the wound site. They initially appear in the wound shortly after injury and subsequently their numbers increase steadily, peaking at 24-48 h [4]. Their main function appears to be phagocytosis of the bacteria which have been introduced into the wound during injury. The presence of PMN in the wound following injury does not appear to be essential in order for normal
wound healing to take place [5, 6], with healing proceeding normally in their absence provided that bacterial contamination has notoccurred. In the absence of infection, PMN have a relatively short life span in the wound and their numbers decrease rapidly after the third day [7].

The next cellular, immune element to enter the wound are macrophages. These cells are derived from circulating monocytes by a combination of migration and chemotaxis. They first appear within 48-96 h post-injury and reach a peak around the third day postinjury [4]. These macrophages have a much longer life span than the PMN and persist in the wound until healing is complete. Their appearance is followed somewhat later by T lymphocytes, which appear in significant numbers around the fifth day postinjury, with peak numbers occurring about the seventh day after injury. In contrast to PMN, the presence and activation of both macrophages and lymphocytes in the wound is critical to the progress of the normal healing process [8, 9]. Macrophages just like neutrophils phagocytose and digest pathological organisms and tissue debris. In addition, macrophagesrelease a plethora of biologically active substances. Many of these substances facilitate the recruitment of additional inflammatory
cells and aid the macrophage in tissue decontamination and debridement; in addition growth factors and other substances are also released which are necessary for the initiation and propagation of granulation tissue formation. These intercellular transmitters are known collectively as cytokines.

Proliferative Phase (Day 3-14)

In the absence of significant infection or contamination the inflammatory phase is short, and after the wound has been successfully cleared of devitalized and unwanted material it gives way to the proliferative phase of healing. The proliferative phase is characterized by the formation of granulation tissue in the wound. Granulation tissue consists of a combination of cellular elements,
including fibroblasts and inflammatory cells, along with new capillaries embedded in a loose extra cellular matrix of collagen, fibronectin and hyaluronic acid. Fibroblasts first appear in significant numbers in the wound on the third day post-injury and achieve peak numbers around the seventh day [4]. This rapid expansion in the fibroblast population at the wound site occurs via a combination of proliferation and migration [10]. Fibroblasts are derived from local mesenchymal cells, particularly those associated with blood vessel adventitia [11], which are induced to proliferate and attracted into the wound by a combination of cytokines produced initially by platelets and subsequently by macrophages and lymphocytes (Table 1). Fibroblasts are the primary synthetic element in the repair process and are responsible for production of the majority of structural proteins used during tissue
reconstruction. In particular, fibroblasts produce large quantities of collagen, a family of triple-chain glycoproteins, which form the main constituent of the extracellular wound matrix and which are ultimately responsible for imparting tensile strength to the scar. Collagen is first detected in the wound around the third day post-injury [12, 13], and thereafter the levels increase rapidly for approximately 3 weeks. It then continues to accumulate at a more gradual pace for up to 3 months post wounding [10]. The collagen is initially deposited in a seemingly haphazard fashion and these individual collagen fibrils are subsequently reorganized, by cross -linking, into regularly aligned bundles oriented along the lines of stress in the healing wound. Fibroblasts are also responsible for the production of other matrix constituents including fibronectin, hyaluronic acid and the glycosaminoglycans [14]. The process of fibroblast proliferation and synthetic activity is known as fibroplasia.

Revascularization of the wound proceeds in parallel with fibroplasia. Capillary buds sprout from blood vessels adjacent to the wound and extend into the wound space. On the second day post-injury, endothelial cells from the side of the venule closest to the wound begin to migrate in response to angiogenic stimuli. These capillary sprouts eventually branch at their tips and join to form
capillary loops, through which blood begins to flow. New sprouts then extend from these loops to form a capillary plexus [15, 16]. The soluble factors responsible for angiogenesis remain incompletely defined. It appears that angiogenesis occurs by a combination of proliferation and migration. Putative mediators for endothelial cell growth and chemotaxis include cytokines
produced by platelets, macrophages and lymphocytes in the wound [17, 18], low oxygen tension [19], lactic acid [20] and biogenic amines [21]. Of the potential cytokine mediators of neovascularization basic fibroblast growth factor (bFGF), acidic FGF (aFGF), transforming growth factors -aand b(TGF-aand -b) and epidermal growth factor (EGF) have all been shown to be potent stimuli for new vessel formation [22-24]. FGF, in particular, has been shown to be a potent inducer of in vivo neovascularization [25, 26]

While these events are proceeding deep in the wound, restoration of epithelial integrity is taking place at the wound surface. Reepithelialization of the wound begins within a couple of hours of the injury. Epithelial cells, arising from either the wound margins or residual dermal epithelial appendages within the wound bed, begin to migrate under the scab and over the underlying viable
connective tissue. The epidermis immediately adjacent to the wound edge begins thickening within 24 h after injury. Marginal basal cells at the edge of the wound loose their firm attachment to the underlying dermis, enlarge and begin to migrate across the surface of the provisional matrix filling the wound. Fixed basal cells in a zone near the cut edge undergo a series of rapid mitotic divisions, and these cells appear to migrate by moving over one another in a leapfrog fashion until the defect is covered [27, 28]. Once the defect is bridged, the migrating epithelial cells loose their flattened appearance, become more columnar in shape and increase in mitotic activity. Layering of the epithelium is re-established and the surface layer eventually keratinized [29]. Reepithelialization is complete in less than 48 h in the case of approximated incised wounds, but may take substantially longer in the case of larger wounds where there is a significant tissue defect. If only the epithelium is damaged, such as occurs in split thickness skin graft donor sites, then repair consists primarily of re-epithelization with minimal or absent fibroplasia and granulation tissue formation. The stimuli for re-epithelization remain incompletely determined, but it appears that the process is mediated by a
combination of loss of contact inhibition, exposure of constituents of the extracellular matrix, particularly fibronectin [30], and by cytokines produced by immune mononuclear cells [31]. EGF, TGF-b, bFGF, platelet-derived growth factor (PDGF) and insulinlike growth factor-l(IGF-l) in particular, have been shown to promote epithelialization [32].

Maturation Phase (Day 7 to I Year)

Almost as soon as the extracellular matrix is laid down, its reorganization begins. Initially, the extracellular matrix is rich in fibronectin, which forms a provisional fibre network. This serves not only as a substratum for migration and ingrowth of cells, but also as a template for collagen deposition by fibroblasts [33]. There are also significant quantities of hyaluronic acid and large
molecular weight proteoglycans present, which contribute to the gel-like consistency of the extracellular matrix and aid cellular infiltration. Collagen rapidly becomes the predominant constituent of the matrix. The initially randomly distributed collagen fibres become cross -linked and aggregated into fibrillar bundles, which gradually provide the healing tissue with increasing stiffness and tensile strength [34]. After a 5-day lag period, which corresponds to early granulation tissue formation and a matrix largely composed of fibronectin and hyaluronic acid, there is a rapid increase in wound breaking strength due to collagen fibrogenesis. The subsequent rate of gain in wound tensile strength is slow, with the wound having gained only 20% of its final strength after 3
weeks. The final strength of the wound remains less than that of uninjured skin, with the maximum breaking strength of the scar reaching only 70% of that of the intact skin [34].
This gradual gain in tensile strength is due not only to continuing collagen deposition, but also to collagen remodelling, with formation of larger collagen bundles [35] and alteration of intermolecular crosslinking [36]. Collagen remodelling during scar formation is dependent on both continued collagen synthesis and collagen catabolism. The degradation of wound collagen is controlled by a variety of collagenase enzymes, and the net increase in wound collagen is determined by the balance of these opposing mechanisms. The high rate of collagen synthesis within the wound returns to normal tissue levels by 6-12 months [37], while active remodelling of the scar continues for up to 1 year after injury and indeed appears to continue at a very slow rate for life.
As remodelling progresses, there is a gradual reduction in the cellularity and vascularity of the reparative tissue which results in the formation of a relatively avascular and acellular collagen scar. Grossly this can be observed as a reduction in erythema associated with the earlier scar and some reduction in the scar volume, resulting in a pale thin scar. This is normally a desirable feature of
healing; however, in some cases shrinkage of the scar may give rise to an undesirable reduction in skin mobility resulting in contracture.
Wound contraction, i. e. inward movement of the wound edge, is a further important element in the healing process and should be distinguished from contracture. Sharply incised wounds without significant tissue loss, approximated early after injury, heal rapidly without the need for significant reduction in the wound volume. Such wounds are described as having healed by primary intention.
Large wounds, however, particularly those associated with significant tissue loss, heal by secondary intention, with granulation tissue gradually filling the defect and epithelization proceeding slowly from the wound edges. Contraction of the wound edges can lead to a significant reduction in the quantity of granulation tissue required to fill the wound defect and a reduction in the area
requiring reepithelization, with a consequent reduction in scar volume. Contraction is only undesirable where it leads to unacceptable tissue distortion and an unsatisfactory cosmetic result. Although contraction normally accounts for a larger part of overall wound closure in looseskinned animals, it still accounts for a significant proportion of the healing process in man, particularly
in areas where the skin is not tightly bound down to underlying structures, such as on the back, neck and forearms. Initially following injury, where the wound edges are not approximated, there is a slight retraction of the wound edges due to the release of normal elastic tension in the skin, with a resultant increase in wound volume. The wound area starts to decrease rapidly from the
third day onwards. While this is due in part to reepithelization, the main reason is an inward movement of the uninjured skin edges. Wound contraction usually begins around the fifth day postwounding and is complete by 12-15 days after wounding [38-40]. Fibroblasts within the wound appear to be responsible for providing the force for this contractile activity [41]. It was initially felt that specialized fibroblasts called myofibroblasts provided the motive force for wound contraction via a musclelike cell contraction [42-

More recent studies reveal that wound contraction occurs as a result of an interaction between fibroblast locomotion and collagen reorganization [41, 45]. The contraction is thought to be mediated via the attachment of collagen fibrils to cell surface receptors [46], with the resulting tractional forces generated by cell motility bringing the attached collagen fibrils closer together and
eventually compacting them [47].
The regulation of wound contraction remains poorly defined. Information regarding the effects of specific cytokines on contraction is limited and often conflicting. TGF-bhas been found to promote contraction even in the absence of serum [48, 49]; PDGF has also been found to either increase contraction [50] or have no effect [49], while both FGF and EGF have been found by different authors to either have no effect or cause a moderate enhancement of contraction [48-50].

Scar Formation
As mentioned previously, the process of wound healing is essentially similar in all tissues and is relatively independent of the mode of injury; however, slight variation in the relative contribution of the different elements to the overall result may occur. The final product of the healing process is a scar. This relatively avascular and acellular mass of collagen serves to restore tissue continuity,
strength and function. Delays in the healing process cause the prolonged presence of wounds, while abnormalities of the healingprocess may lead to abnormal scar formation. Successful completion of wound healing may not always yield the desired clinical result, particularly where the final cosmetic appearance of the scar is of primary importance.

12 keys unaddicting your brain

In this part we explain the 12 Keys that have proven most helpful to people kicking their addiction. Think of it as a boot camp for your brain. The 12 Keys are simple steps you can take to give your brain, and your psyche, the equivalent of a trip to the health farm. And it works. By eating healthy foods and taking the absolute optimum amount of key nutrients you reprogramme your brain and body chemistry so that you quickly start to experience a state of natural energy, clarity and steady mood – in effect an enjoyable natural high. Because of this, you’ll find the desire to use an addictive substance far less strong.
Don’t underestimate the power of your brain

It is important to remember that there is no ‘1 Key’ solution to addiction. If you’ve been using addictive substances for many years, possibly in large quantities, your brain will not simply be ‘reset’ by eating a so-called well-balanced diet. Similarly, if you’ve experienced major stresses and traumas in life you don’t just recover by leading a balanced life. There is damage that needs to be undone. You have to reprogramme your mind and rebuild your brain. If you’ve seriously scrambled your brain, just sitting in a room and talking about your past isn’t going to unscramble it.
The bottom line is that if your brain is programmed for addiction, with all the will in the world, and the best counselling, and even some of the new addiction drugs that make you feel sick if you use the drug of your choice, nothing is stronger than the impulse of your brain telling you that your survival depends on having tis substance. Biological urges are immensely strong. You try not breathing, or not peeing, for example. We take our hats off to those who have quit when all the cells in their body are screaming for a cigarette, a drink or a drug. That’s definitely the hard track.
The easier track is to work with your brain’s natural design, not against it, by restoring the imbalance, not with drugs, but with the very nutrients that your brain has evolved to use over millions of years. This approach not only reprogrammes your brain and your body’s chemistry to make you feel good naturally, but it also reprogrammes how you react to the triggers that lead you to take an addictive substance. As your brain, mood, concentration and energy start to come back to life so does your capacity for learning and resolving psychological or life conflicts that may be part of you getting stuck in some level of addiction. Hence counselling is much more effective in optimally nourished people. Although psychological issues, such as feeling completely stressed or depressed, can lead you into addiction, once you are in it, the brain’s chemistry becomes reprogrammed, and simply solving the reason for your stress or depression, and avoiding the substance, doesn’t reset your brain’s chemical balance. The best way to achieve this is through the programme presented in this book.
Success is proven

This isn’t just talk. Our approach works in the real world. For example, in one treatment centre, Bridging The Gaps in Winchester, Virginia, which has incorporated these 12 Keys into their treatment agenda, along with intravenous nutrient therapy, the success rate has gone through the roof. We followed up 23 clients one year after they had started the equivalent of this How to Quit approach to quit their serious drug and alcohol addictions, and found that of the 23, 21 were clean and sober. That’s an incredible 91 per cent success rate! The usual one year success rate (meaning still clean and sober) for other methods of quitting is around 20 per cent. Of the 23 participants, 16 (70 per cent) had not even had a brief relapse – not a single drink or use of any drug.
Using the 12 Keys

The 12 Keys to Unaddicting Your Brain are designed to help you understand the solutions that are right for you. The first six define what ‘optimum nutrition’ really means in terms of unaddicting your brain: how to find out which amino acids will most rapidly reduce your abstinence symptoms; the kind of foods and supplements to take to get the best intake of essential fats, vitamins and minerals; and how to improve your ability to digest and absorb these nutrients. The next three chapters on getting a good night’s sleep, solving hidden food allergies and rejuvenating your liver, will be more applicable to some readers than others, but please read them all to see if they address issues that relate to you. The last three chapters explain what you can do to raise your feelgood endorphins naturally, generating vital energy and emotional healing – all have the effect of increasing your energy.
Get support

Although everything in this programme can be done at home, if you have a serious addiction we encourage you to work with a team of health professionals, including a nutritional therapist and psychotherapist, or a treatment centre that uses most of these 12 Keys to Unaddicting Your Brain. If your treatment centre choice does not incorporate our How to Quit nutrition approach you can always also attend, as an outpatient, the Brain Bio Centre in Richmond, Surrey (see Resources) to find your ideal nutrition prescription.
Add value to your programme

Whereas the optimum nutrition approach to reversing addiction is a vital missing piece we do not believe that it is the only piece of the jigsaw and recommend you do anything and everything that works for you. There is no contradiction to adding our How to Quit programme to any other method or technique for reversing your addiction. (If you are on prescribed medication please make sure you read Chapter 7 as there are some amino acids that should not be taken alongside certain drugs.)
Moving on

In Part 3 you’ll find out which of the keys we outline here will make the biggest difference to you, depending on which substances you want to quit

The effect of cigarette

‘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

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

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