Medication

From my layperson's perspective, there doesn't appear to be a lot of medical research into addiction. I suppose it is a little bit like malaria.  It's not news because it happens all the time.  News is reporting what's new or different, or what's changed.

I am heartened to hear of new medication options that might help people struggling with addiction.  (This is link to the radiolab episode "The Fix").

I remember when SSRIs were becoming more mainstream in the early 90s.  It's amazing how much difference medication can make.

Many friends (including me) were anti-medication.

And there are good reasons for the skepticism.  The psychiatric community historically has discriminated against women (if not people of color).  And that's completely ignoring the treatment of the LGBT community until quite recently.

But I also know many people who have benefited from the medications (including me).  For me, I think it's pretty obvious.  Just like my body not making enough thyroid hormone, my brain doesn't appear to handle serotonin appropriately.  For me, it's been an simple equation - I take thyroid medication, and my symptoms decrease.

So I agree with the notes in the podcast that medication radically changed how people viewed mental illness and talk therapy.

With that said, I still see a tremendous amount of value in talk therapy (i.e. Cognitive Behavioral Therapy).  Medication can work wonders, but there are still thought patterns that may need to be examined.  There are relationship skills that need to be learned (or strengthened).  CBT can help a person develop boundary setting and healing from trauma that cannot happen just through taking a pill. And it doesn't have to be a life sentence.  Medication may be needed for a short amount of time for getting through something (like death or a divorce), but can also be decreased over time.

So medication for addiction may be incredibly helpful for those struggling with addiction.  But in the end, there may also be a great deal of value in examining the underlying issues of addiction.  How does a person deal with the uncomfortable feelings that led to the addiction in the first place?  How does one interact socially when all social interactions involved a substance?

It's incredibly complex, and I'm not even scratching the surface of the issue's complexity.

Prohibition

I enjoyed watching Prohibition, the latest documentary from Ken Burns.  A friend of mine observed that prohibition would never have passed if women had rights (been treated better at the time). 

I agree wholeheartedly.  

What I found interesting, however, is the education in schools prior to prohibition.  The Women's Christian Temperance Union, and the Anti-Saloon league successfully lobbied for laws to teach children about the danger of alcohol.  One of the things they claimed was that one drop of alcohol could lead to alcoholism.  This was part of the curriculum for children, who also pledged to never touch alcohol throughout their lives.

This was fascinating to me.  First, I didn't realize that this argument (currently used against illegal drugs/drug abuse) had been used against alcohol in the U.S. 

To bring it to mormonism (being raised mormon), I always thought the history of alcohol and mormons was interesting.  Drinking alcohol is prohibited by mormons, but many church leaders had breweries or wineries.  Brigham Young owned a bar in Salt Lake City, for example. My family legend suggests one of my ancestors owned a saloon in Utah, one of the first in the region.  

According to wikipedia, it was in 1902 the word of wisdom (abstaining from alcohol) became necessary to enter mormon temples (to be married or to attend the weddings of family members and friends).  This would have been right around the same time that prohibition fervor was growing in the country. 


The way it was taught to me growing up, was that I should never try a sip of any form of alcohol.  Period.  Trying even a sip of alcohol was sinful.  And, it could cut me off from the spirit, from contact with God.  It's a powerful argument, to suggest that a substance immediately cuts someone off from any direction or protection from God.   

As a teenager, I thought this interpretation was extreme.  I didn't think that trying a sip of alcohol would lead to alcoholism, although many mormons suggested that to me.  Were they just trying to get a message through to teenagers, or explaining something they sincerely believe(d)? 

I am not sure that any research shows that an occasional beer or wine leads to alcohol abuse.  There really isn't a clear line between a sip of champagne and buying a case of beer instead of food. In my opinion, there is a huge difference between the two, and true alcoholism takes years.  If anyone can even explain what alcoholism is and who suffers from it (it's fairly controversial).  Since most everyone has tried alcohol at some point, why aren't more people alcoholics?

So in my opinion, it does a disservice to all mormons to continue the strict adherence and ban on any forms of alcohol, to encourage people to refrain from trying a sip of alcohol.  It's really not a black and white issue. 

Why not encourage moderation?  Why not learn how to drink responsibly, but also how to make up your own minds about what substances/food/cultural experiences you will embrace?  Why not teach children and families what true alcoholism is, what some signs can be (when sober is your altered state of being), etc.

In terms of mormon doctrine, the strict adherence is really a modern interpretation.  The Word of Wisdom was never fully required, it was just advice (as chanson points out aptly in her novel exmormon). 

But mormonism (whether or not it's doctrinal or cultural) appears to be about fifty years behind the times.  In this instance, perhaps the leadership is 80 years behind the times of re-examining strict prohibition of alcohol, and allowing personal responsibility and moderation.

Anxiety!

My anxiety levels have been through the roof recently. And it's odd (for me) because nothing has really changed.

Things are going well and have been pretty stable for some time now.

I hesitate to even mention this, as it's over-sharing no doubt, but I also try to be pretty honest about my journey and where I'm at.

And, if there is one person reading this blog who has ever been remotely near this place (where I am), and thinks twice about getting help because they think "well, aerin did it, so maybe I can too" - that's why I'm bringing this up.

So a person doesn't feel like they are the only person on earth who has ever felt this way. Where I physically feel a tightness in my chest - it's hard to breathe.

Deep breathing/meditation doesn't seem to help. Haven't broken out the "Anxiety and Phobia Workbook" yet, but that's helped in the past.



I'm going to make an appointment and get it checked out. Who knows where the journey will lead.

I'm so thankful that the stigma on this type of thing is disappearing.

It is still there. And it's not covered by some health insurance (another complaint I have)....

Sometimes I still even hear people say something like "you have to be really crazy to..." but honestly, I feel it's a little like alcoholism and addiction. Sure, there are a ton of people out there who are severe alcoholics/addict, the wild off the wall non functioning type who are homeless, family -less or worse because they can't stop drinking - the 10% or so. Then there are the rest who may have a problem, but they keep up with their job, their families, some of their responsibilities. In other words, functioning alcoholics.

Yeah, I know that functioning line is hard to draw.

What I'm saying is, I don't have to have lost everything in my life to realize I need help.

Someone wise I read recently mentioned that in our culture/society - we know so many buzzwords for self-help and therapy that we don't think we really need to work on things - with a professional. The idea of opening up can be terrifying.

I grew up in a family where the stigma was incredibly real. As I've mentioned before, my own mom went years before being officially treated and diagnosed. I remember hearing that shrinks weren't interested in helping anyone, just keeping people in therapy. I heard that if we all just prayed more, and read the scriptures we would be okay.

And I can't help but think sometimes about all that wasted time. If we hadn't been fighting that stigma as a family.

Ignoring the problem didn't work for us then and it will definitely NOT work for me now.

So I'm going to continue to breathe. Wish me luck.

Socially Awkward (with mashed potato bonus)

I've worked with at least two people who would probably fall on the autistic spectrum if they were tested. Working with such people in cubicle land can actually be quite stressful.

Because it's not easy working with anyone who doesn't read social cues - who doesn't pick up on what is appropriate and what is not appropriate. (News flash: talking about your exercise regimen at full volume for an hour, probably not appropriate). I too struggle with this line, but I think I do pretty well most of the time.

I have compassion for them, but that doesn't make it any easier to be around them.

Wry talked about arguments in her post here. I think because of my experience with people with mental illnesses, I find it's a lot easier to just let a conversation go.

I'll give an example. I feel like I've mentioned this before, but couldn't find the post. One person (we'll call him person A) went up to my boss one day. (My boss worked in the cubicle next to mine). He (person A) started out the conversation with "Well, she finally did it". My boss asked what he was talking about. It turned out that his niece had taken her life a few days before. She (the niece) had struggled with depression and addiction.

His flippant attitude really angered me. I thought - how incredibly sad. If I know anything about addiction and mental illness - it's that no one chooses to be there. Most addicts and people who suffer from mental illness deserve our compassion more than anything. Not that we have to enable their behavior - but at least have sympathy.

After I heard this uncle, I had an incredible amount of compassion for his niece - for living in such a family. Sure, she probably made mistakes. She may have even made a lot of mistakes. Stealing from family, ignoring responsibilities, lying, etc.

My point in this story is simply that - this co-worker of mine had no idea that I would find his attitude offensive. That I have known many people over the years who were suicidal and who have suffered from addiction. I've watched families break apart and friendships end over what happens. Some people never get over the loss.

I didn't want to share this with this person - I doubt he would change his opinion even if he knew. (For the record, I got into another discussion with this co-worker about ingredients in mashed potatoes. Just so you know, sour cream and chives are not valid ingredients, just butter, milk, salt and pepper).

So when I think of my energy for these types of conversations, this is exactly what I'm thinking about. I could argue with this person for hours about mashed potato ingredients and not get anywhere. And in the process - I would miss out on life passing me by. A beautiul sunset - throwing snowballs at my kids, making pumpkin bread. If nothing else, time I could have spent clearing my own head, meditating.

If this person wants to believe that addiction is a weakness and good mashed potatoes don't have sour cream in them - that's their right. I'm not going to waste my time in that discussion.

Biology Does Not Mean Competancy

I've been reading recently - a handful of memoirs about growing up in families ravaged by alcoholism. What is both sad and intriguing to me is how common many of the experiences are. Some of the stories are simply heart-breaking. In most of the autobiographies - the father is a severe alcoholic, and the mother works hard to deal with him and to provide for her children.



In Rick Bragg's All Over But the Shoutin', his mother fought to care for her sons. Despite being beaten by their father when he tried to look for work. And, at multiple points, she picks up and returns to her family, swallowing her pride, so her children wouldn't starve.

Jeannette Walls' family, in The Glass Castle did not have such a strong mother figure. In almost every instance, her mother did not support the physical needs and well being of her children. She would descend into self-pity, hiding under the covers and eating chocolate while her children went hungry. Despite having a teaching degree (and license), she refused to teach until begged to by her children. Even then, her pre-teen daughters had to wake her up, help her with lessons plans and grade papers for her. After a year, the mom quit to spend more time with her art. The family, at this point, lived in a shack with no indoor plumbing and garbage rotting outside. The parents refused to go on welfare, as it would damage their children's "self-esteem".

Instead, the children dug through the garbage after lunch at school to eat what had been thrown away by other students.

Would either author be as gifted without these experiences? I am a firm believer in "That which does not kill us, makes us stronger".

With that said, I think as a society, we have to have a system to help these struggling families. At times, it may mean that children are removed from their families. (As an aside, for the record, I don't feel that would have been necessary in Rick Bragg's case, I don't know all the details, just wanted to point out his memoir as another sad example of a family torn by alcoholism).

My point is, life isn't fair. Just because you are able to conceive or bear children, doesn't give you the right to abuse or neglect them.

So often, this seems sacrosanct in our culture. By definition, this is a "sacred cow" - biological parents and families are ALWAYS best. Despite the very real occurrences of abuse and neglect.

Who makes this decision? Who decides which parents should keep their kids (and can potentially clean up their act) and who has lost that privilege?

In the current U.S. system, the department of children and family services (DCFS) makes that call. It's not the best system. It's rife with problems, including corruption. Sometimes, children are moved "Out of the frying pan, into the fire" - from one bad family to a foster family with issues. And systematic abuse and neglect are often not identified until children are in school, long after life-long devastation has been wrought.

On top of all of this, some parents take the threat of their children being removed very seriously - using it to get the help they need to get and stay sober (or to get healthy). And it has been shown repeatedly that children do better in their original family unit if possible.

So where does that leave us?

What one person considers "unfit living conditions" may not constitute those for someone else. This was debated recently with the FLDS situation in Texas. Over 400 children were removed from their parents See MSN story here.

The high court decided in favor of the parents in that case - there wasn't a clear and present danger to the children. I've eaten crow on this one. I honestly thought (from the rumors) that hard evidence was available or potentially available that each of the children might be in danger. Or that children may have been removed from their birth mother and/or taken out of their original country (i.e. Canada). The data wasn't there, justice was served and the majority of the children were returned.

Simply because we disagree with a parent's lifestyle or religious views does not mean that the parent is unfit or that the child is being raised in an unhealthy living situation. The idea that a child would be taken from an otherwise loving home because their parents are atheists or lesbians is laughable to me (chanson mentioned it in comments to this post here. It is something to consider. As a society, we need to make sure that we are removing children to protect them, and for the right reasons. Not because of philisophical, religious or lifestyle disagreements.

In Jeannette Walls' memoir, if what she writes is true, I believe that those children may have been better off in foster care. Hindsight is always 20/20. And I don't, obviously, know the situation like someone living it would, or a case worker would. I won't share all of what she wrote (you'll have to read the book for that) but if you read the book and do NOT think those children experienced textbook physical neglect, we can discuss it. When a three year old is happier in a hospital despite third degree burns) because of the calm, quiet and consistent meals - there may be a problem. When a family eats rotten meat to develop better immunity, there might be a problem.

Yet looking back on it all, I'm not sure that Walls would have wanted to live in another family - to be put into foster care. At twelve, when a case worker stops by to talk with her parents, she lives in fear that she'll be taken from her siblings and that they'll be put in different homes. Even if they would be able to bathe regularly and eat consistent meals.

As I mentioned above, foster care has its own set of issues. I won't go into those either, other than to say that this is not a black and white issue.

Each case is unique and has an individual set of circumstances. What works for one family, doesn't work for another. At times, there are competent extended family members. Sometimes there aren't. I'm not defending DCFS, but I believe that we are better with that system (even a broken system) than nothing at all. I support multiple case workers and a judge making the decision based on evidence.

I do have a tremendous amount of compassion for children and parents in these families. In each memoir I've read (like Frank McCourt's Angela's Ashes), the families survived because of the charity of others. They are remarkable stories, and remarkably strong people to have lived through what they did - and lived to tell about it.

This is a link to the video produced by Jeannette Walls' about her book. We watched a little of it at my book club, it was so interesting to see her Mom and her paintings.

Addiction

NOTE: I don't understand a great deal about addiction. Neither of my parents were addicts. I do not mean to be presumptuous in this post. Just state some thoughts I've had and my reaction to comments. I'm always willing to discuss/learn more.

I believe addiction is a disease. It is a disease like heart disease and hyperthyroidism.

I believe it is genetic. It is inherited just like mental illness (and a whole host of other diseases/conditions/traits). I believe some of us are genetically predisposed to addiction, just like some may be predisposed to writing, music, cooking, driving, reading maps or different forms of ear wax.

People can be in denial about their addictions. Denial is very powerful. And addiction (specifically alcoholism) is debated in many circles. What, exactly, makes one an alcoholic? Drinking alone? Drinking liquor/whiskey/bourbon? Drinking in the morning? Drinking every day?

From my limited understanding, the only person who can label or admit a person an alcoholic is the person themselves. (As an aside, this is very confusing to me - as Al-anon is a group for family and loved ones of alcoholics. But a person can join whether or not the original qualifying person admits to being an alcoholic in the first place. So are they really an alcoholic? Should the loved one still attend? The jury is still out.) I'll just admit to not understanding that process.

Yet I feel there is a clear (intuitive) line when a person has a problem with alcohol (or other substances). I'll give two examples.

The first is a friend who was out of work (from my college days). I specifically remember instances where he had to choose between buying a thirty pack of beer or food with his last $5. He chose the beer.

Another person we know has had two drunk driving arrests within a year. In the state we live in, this is an automatic felony. In the second instance, he wrecked the car he was driving. Fortunately (as there are so many, many sad stories of people being killed/maimed by drivers under the influence), no one was hurt.

I could make arguments in both cases that both these people have some sort of problems with alcohol. The exact nature of those problems, I couldn't say. I do know enough to say, you may have a problem when...

What I want to explore further is the power of denial about addiction and the mental gymnastics a person can go through.

When I say mental gymnastics, it's what can happen when a loved one confronts a potential addict about their possible addiction. The addict responds "Well, you can't give up X." I think of X as a relatively harmless substance in moderation: coffee, chocolate, exercise, tv, the internet or frozen juice pops.



What's fascinating to me is the dynamic this creates. It throws the focus off of the potential addict. Because typically, the friend/loved one has to admit that yes, they do love substance x (we'll say coffee). And yes, it would be hard for them to give it up.

My argument is, the conversation should not stop here.

Conventional wisdom is that people can be addicted to anything. Again, examples of chocolate, coffee, exercise, the internet, etc. come to mind.

But it does beg the question of what exactly a "dangerous" addiction is.

Let's just say (for the sake of argument) that I'm addicted to coffee.

-Coffee is not a controlled substance (anywhere on earth).

-If I drink coffee and drive, my driving is not impaired by the coffee itself.

-It's not illegal to drink coffee and drive.

-I don't become violent while drinking coffee.

-I don't black out after drinking a cup of coffee and not remember where I am or how I got there.

-Coffee drinking doesn't take me away from being fully present when interacting with and caring for my children.

-I won't get fired for drinking coffee at work.

-My doctor won't tell me that drinking a couple cups of coffee every day is dangerous to my health, heart and liver. (in fact, some studies show that drinking coffee can help fight diabetes and Alzheimer’s, although the medical consensus is still out on those).

-I don't hide my coffee drinking or lie about it.

-I do get sick when I stop drinking coffee - so that is a yes answer among the others.

With dangerous addictions, when you add substance x to that list and begin answering yes, I submit that you may have a problem.

I'm not implying that alcohol in moderation is always bad for a person. Growing up LDS (well, it was mormon back then), I was taught that alcohol (even a sip) was a sin. If a friend's parents had beer in their fridge (even six month old beer), they were probably alcoholics.

This was/is an unhealthy attitude as well. Someone with beer in their fridge is not necessarily an addict. They are not necessarily dependent or powerless against alcohol - where it is the most important thing in their life. They are not in the position where they will sacrifice everything else to get that substance. An LDS child is not taught to see grey in alcohol consumption, they're not taught what "normal" consumption is and what is abusive/dependent.

What makes this even more complex is that alcohol use is glamorized in our society/culture and in the media. I've seen the sixteen page intake questionnaires that addiction facilities use. I will say, if many people I know answered those questionnaires truthfully, I know quite a few alcoholics.

My point in all of this is not to create paranoia in my readers. I hope to have other posts to respond to the recent addiction posts around the LDS internets.

What I am saying is that if someone confronts you saying "You have a problem with x" - I think it's worthwhile to have a discussion about it. Why do they think that? Research different prevailing medical and therapeutic opinions about addiction. Determine what is a dangerous substance or behavior. Talk to friends and family - what do they see?

But like coffee or chocolate, if it doesn't fit, it's probably not a bona fide addiction. There may be larger issues going on in the relationship. It may be worth going to therapy to figure out what else may be going on.