By Marc Dunn
Once again a beloved celebrity, Robin Williams, has died as a result of his addiction to drugs or alcohol and the depression that goes along with it. If you are reading this, probably you are, or someone you know very well, is an addict. The number of people affected by addiction either directly or indirectly, is staggering. Yet we are shocked by the deaths it causes. And we continue to be uninformed or misinformed. This has to stop.
I didn’t know Robin Williams, nor will I presume to be able to explain his apparent suicide. I do know that he has admitted he was powerless over his addiction and had relapsed many times. Addiction is cunning, baffling, demoralizing and devastating disease. For too many it remains a secret, cloaked in anonymity.
Robin Williams was beloved by us all, as was so many actors, singers, and talented people who lost their lives to addiction. But celebrity deaths are the same as thousands of other addicts who die every year in automobile accidents, boating accidents, overdoses, suicides or numerous other ways as a result of their addictions. They leave behind families and friends and spouses who loved them.
Those in recovery must speak out about the actions we took to find a better way of life. We owe it to our families and friends to talk about addiction and recovery and what it takes to change. Our continued drinking and drugging never ends well. We use because of a disease, like cancer, that is not curable but can be treated. If we die, others continue to suffer because of the devastation we leave behind. Everyone else must now deal with the pity, the looks of despair, the awkward explanations and questions and worst of all the feeling that there was something wrong with those we left behind because they couldn’t fix us. None of it is true. We die as result of not making good choices.
Writing and speaking about addiction allows me to be of service to others who seek recovery. I believe with every fiber of my being that recovery needs to have the faces of everyday people on it, not mysterious anonymity that deprives those sick and suffering of hope because they think only those with special access to help can find a solution.
There isn’t an easy solution, no softer easier way. It takes dedication to a new design for living. We have to change our habits; eating, fitness, therapy, acknowledgement of our limitations and a connection with a power greater than ourselves. It doesn’t have to be a 12-step program; there are many other ways to find recovery. It does require discipline and changing the persons, places and things that we associated with during our addiction.
It is time for recovery to come out of the closet and those of us comfortable with speaking about our recovery to do just that. Others lives depend on it. Many of us have been told not to speak publicly about our addiction because of the negative ramifications, or because it may reflect poorly on our fellowship, or it may cause us to inflate our egos too much for our own good. And inflated egos can result in a relapse. But the identification publicly as a person in recovery, not as a spokesperson for any group does save lives. We can be a regular guy or gal who has found a way not to drug or drink. And telling that story helps.
Whether by writing, speaking or filming we must carry this message. We must let others know that recovery is a courageous choice.
If, “our primary purpose is to stay sober and help others to achieve sobriety,” as 12 step programs say, then why wouldn’t we use 21st century tools to carry that message? I am a recovering addict. My name is Marc. I have not had a drug or drink since November 28, 2005.
By Marc Dunn
By Nicola O’Hanlon
Reblogged from http://iloverecovery.com/2014/07/23/is-there-an-upsurge-in-12-step-bashing/%22
I’m not sure if there is currently an upsurge in 12 Step bashing recently or if I’m just, by accident, coming across a lot of it. It seems everywhere I turn this past few months there’s a new book, or article or ex 12 step member with a blog telling of the evils or 12 step fellowships; spouting about the ridiculousness of 12 steppers relying on a Higher Power to get them sober as if it was akin to something out of a fairytale. Now I’m not talking about people who have differing opinions per se. That’s a whole different thing. I am whole heartedly supportive of any fellow human on the path to recovery finding what’s best for them and I totally get that 12 step is not for everyone. In fact I have friends who left 12 step fellowships after many years of sobriety and are doing great without it, at least for now. There are of course many avenues to recovery from the long list of addictions in our society today, which in my opinion is a very positive thing. But is there any reason to be down on a program in such an extreme manner that has worked for millions of people for seventy plus years? So good are the bashers at manipulating words, that sometimes when I read these assaults on 12 step it makes me feel like I should be ashamed about being pro 12 step. This of course is ridiculous. Personally without them I’d be up to my neck in every addictive substance known to man and probably creating new ones. But really, I feel sometimes that the term”12 step” has almost become a derogatory term in some circles.
What really bothers me the most is the way anti 12 steppers misrepresent what the programs are really about and they manage to do this beautifully by using the term “powerless” in a negative manner. They just love to make it sound like 12 step attendees are subjected to a barrage of negative, soul destroying, brainwashing; their self esteem being crushed by old timers diminishing their already sparse self worth by telling them they are powerless and must conform to their evil ways. What a pile of crap. Of course most of you will know that the term “powerless” is mentioned in the first step. But what it actually says is I am “powerless” over alcohol, or “powerless” over food, or whatever your preferred substance or behavior is. It does not say you are a powerless good for nothing. Quite frankly, in my humble yet quite extensive experience, being powerless over certain substances is absolutely true for those of us who find ourselves addicted. Once an addict ingests their drug of choice they have little or no control (or power) over how much of that substance they consume or what the consequences will be. Quite a simple and realistic concept don’t you think? It is a fact, for example, that if an alcoholic drinks alcohol it triggers a physiological and mental process in the body that produces craving and obsession. And that’s an actual scientific fact, not something I or anyone else just plucked from obscurity. Yet the term will be used in misrepresentative rants by people who, it seems, are determined to debunk the reputation of 12 step programs.
Then of course, there’s the God thing. Oh boy how the haters love to beat this one with a big stick. Apparently, in 12 step groups everyone must conform to the one idea of a Christian God, and if you don’t, the old timers will come and get you-Again! Actually it is my understanding that most 12 step groups have their fair share of atheists and agnostics and that there is actually no requirement to believe in any form of god. I certainly know of people in 12 step groups in my area that use the G.O.D. term to interpret Good Orderly Direction, and they look to the collective group for their “Higher Power”. Anyone I’ve spoken to has never been told that they need to believe in a preconceived idea of a Christian God nor a God of any other faith for that matter. Here’s my humble experience again, sorry! I have never been looked down on because I do not follow Christian beliefs nor have I ever had an old timer chastise me because my idea of a Higher Power is not the same as theirs. Believe me, having been raised in a staunchly Catholic era in Irish history, any notion that it was necessary for me to conform to Christianity would have been rejected in a rather forceful manner. In fact what I’ve found is the total freedom to believe in something I chose or in fact, to believe in nothing at all. I experience nothing but encouragement to think and express myself freely, and I do. I’ve made plenty of wrong turns and mistakes in my recovery and I have been nurtured through them, not told that I’ll burn in hell for all eternity. The only people that I have ever been ridiculed by about my beliefs are by people outside of 12 step groups.
Another bugbear for me is the fact that some like to ignore the fact that addiction is about far more than the substance. I’m constantly reading statistics about how the majority of people experiencing addiction to alcohol, manage to get sober by themselves without any form of program. So is that physically sober? What about the other components of the disease? Now maybe I’m a vastly inferior being, but for me there is no way on this earth that I could have fought this disease alone. I absolutely need help from an army of people to kick my many habits, and I will reiterate, that no, I don’t think 12 step is the only way, but it does work.
I’ve also read on several occasions that people felt pressured by other members when they talked about the use of anti-depressants, that its frowned upon in the 12 step world. Well, actually, yet again, more crap! In my 12 step world, seeking outside help when needed is highly encouraged, and boy have I sought it. I’ve never once been told to stop taking medication but to always follow medical advice on such matters and that I should be commended for being honest enough to realize I needed further help. I believe it talks about that old “seeking outside help when needed” in the original 12 step text, which is AA’s Big Book. It also says something in there about it not being a cure all. Maybe anti 12 steppers failed to read that text and just don’t know.
It has often occurred to me that perhaps I’m just really lucky to have found so much love and encouragement inside the 12 step groups I attend. However, I’m surrounded by hundreds of people who have had the same experience, so I don’t think it’s luck. I am also very aware that in EVERY organization, be it religious, political or otherwise there will always be a percentage of bad eggs who will want to take advantage of people and be in control. I’m sure lots of people have had bad experiences and that perhaps there are groups in general that are just not working 12 step principles but their own version of. Of course there is going to be those who will use their perceived power and knowledge to prey on people. I hear about that all the time too. The men are just unscrupulous sex crazed abusers, right? Here I go with my opinion again! Actually no, they are not. While I absolutely do not condone the predatory nature of some members, none of us got into 12 step groups for being Mother Theresa and we are not going to become her over night. I’m sure if you scratch the surface of any recovery group you will find those who have ulterior motives. Lots of our behaviors follow us into recovery, and changing them takes time. Many of us are really sick puppies. There are dangerous, unethical people everywhere in society, including 12 step groups. However, those people and or groups do not represent the majority nor the real essence of 12 step ethics. There are thousands of groups to choose from and if you don’t like the atmosphere and philosophy of one then find another.
If I was to spend my time nit picking over every word that has the potential to offended me inside a 12 step setting, I’m sure I’d be turned off too. I chose to listen to the real 12 steppers who promote freedom of thought, expression and attitude and talk about spiritual principles. I avoid the sexual predators and egomaniacs, and let them get on with their program. After all it’s rarely a secret as to who these members are. I do however, keep my mind open, just in case I don’t actually know everything, and give myself a chance to learn something. It helps when you chose to focus on the reality of what 12 step programs have brought to millions of people all over the world and not the agenda filled naysayers. Perhaps I should just stop reading these malignant articles. I might just keep my sanity a bit longer.
Twenty-three years ago I could not imagine getting through a day without drugs and alcohol, and frankly, I had no intention or desire to do so. Now, twenty-three years later, I cannot imagine a day that would include drugs and alcohol. There has been a profound transformation at every level of my being. Almost everything is different. My body and my thinking have changed. My understanding of the world and my place in it has certainly changed. My relationship with the Power I cannot touch or see, while still ineffable, has developed into a very real detectable experience. What has not changed is the Truth within me. By definition, Truth is that which never changes. Therefore, all the changes I just referenced cannot be considered the Truth with a capital “T”. Yet, within this being called Tommy Rosen there is a Truth (as is the case for you) and these 23 years of recovery have served to bring me closer to it.
I’m never going to be able to do anything more profound than realizing that Truth within me, or perhaps helping another person to do so for themselves. In Kundalini Yoga as taught by Yogi Bhajan, the mantra which best expresses this idea is Sat Nam, which means Truth is my identity. I did not set out to learn the Truth. I just wanted to feel better. For a while drugs did that for me. Then the drugs became a source of more pain than what I was originally trying to fix. Everything happened in stages for me. There were the 12 Steps. There was the path of yoga and finally learning to sit still and meditate, which has been one of the great gifts of my life. There was the complete overhaul of my relationship with food and my relationship with money. With each successive stage there was more strength, more clarity, but there was a lot of pain along the way. I had to lose the myth that pain only happens if you do something wrong. That idea compounded my pain and messed with me. I have to thank all the sponsors, therapists, friends and family members who shined a light on the path and loved me along it. As a point of fact, all the progress I have made in my life has come because of the efforts, care and love of my teachers. One of my teachers this year came in the form of a whole family. They gave me a huge lesson about courage and taking life on life’s terms. Here is how it happened.
There is a man I have become close with through powerful face-to-face connections that take place each Summer Solstice at the worldwide 3HO Kundalini Yoga gathering. I love this man and we have had a heartfelt connection from the beginning. This year, I met and spent a bit of time with both he and his wife. They told me a story that struck me to the core of my being and I am compelled to share it now. Their son and his wife got pregnant with their first child together. They ran through the normal necessary pre-natal tests and learned that their baby boy had a very rare disease. He would likely make it to full term and be born, but he would likely live only for a few hours. The couple and their family could not imagine stopping their pregnancy before this little soul had a chance to live…even just a few hours. Despite knowing that they were going to have to face excruciating pain and grief they decided to have the baby anyway. Such is the emphasis Yogis place on the blessing that it is to have an incarnation as a Human Being.
I’m sitting there listening to this story and the sheer courage of it cracked my heart wide open. In a world where most of what I see is people trying to duck pain, here was an example of a family that leaned into it. Who would choose to have a baby knowing they would only get a few precious moments with it?
Extraordinary people, that’s who. Their beautiful baby boy was born and flourished for 3 days, much longer than anyone had expected. The family reports that there was a sense of wonder and awe about this child. He was truly grateful to be alive and they were truly grateful to have afforded it the opportunity. When I ask my friend what the greatest gifts were from this whole event, he tells it like this: “It taught my children, my wife and I to live in the moment, one day at a time. And not just to live in the moment, but also to actually notice the moment like when the dragonfly hovers there in front of you or when the goldfinch flies by. We know for certain that life does not end with the physical and there is proof of that all around us if only we pay attention to the signs.”
What I have taken away from this story is a clearer sense that nothing would have been possible for me without the gift of recovery, without a spiritual approach to life and without a community of people who are carrying so much light that they shine a path ahead for all of us.
This is what occurs to me at the beginning of this new year taking life on life’s terms and one day at a time.
Sending you all my Love, Gratitude and Strength in our pursuit of the Truth within.
Tommy’s upcoming book, 2.0: Move RecoveryBeyond Addiction And Upgrade Your Life, which comes out Oct 21, 2014? Here is the link for pre-order http://bit.ly/1mkV54uContinue Reading...
References to Scriptures on this Blog are not to put forth any Religion but to draw comparisons to Spiritual values or principles and our Recovery. I apologize if you are offended by the reference to a Religious Scripture, but our Spiritual Principles are drawn for all Religions and Spirituality.
The term “appointed time” in Scriptures generally denotes a holiday or other special occurrence. Why then is the daily offering referred to as taking place in an “appointed time”—a term that normally indicates something rare and infrequent? Seemingly, the daily offering has no appointed time; for its time is all the time.
In understanding this curious choice of words, we will uncover a key principle in the service of Our Creator that should be familiar to those seeking a spiritual renewal.
We often speak about staying in the “here and now.” We seem to have a predisposition for spurning the present and preoccupying ourselves with some real or imagined “big event” in the future. Our anticipation of the “big event” may take on divergent forms ranging from idealistic and dreamy expectations to morose and debilitating anxiety. But whether it is with grandiose expectation or disproportionate fear that we anticipate the “big event,” one thing is for sure—we have very little interest in living the moment that is right now.
We don’t understand people who “stop and smell the flowers” and extol the simple pleasures of life. Some of us wouldn’t recognize a “simple pleasure” if it jumped up and bit us. Looking back on our lives, we may consider how many perfectly lovely moments have we spoiled with our fixation on some payoff whose time had not yet or would never come.
It is no wonder that we didn’t experience life’s joy—we couldn’t get through life’s major episodes or through everyday life, in the moment. We were either feverishly busy with trying to turn “now” into the “big event,” or sulking over the fact that it wasn’t. We so wanted that things should always be special, never ordinary.
Thus we are told that the time for the continual offering – brought twice every single day – is in fact a special time. Any moment that is used as an opportunity to bring something to someone else or to our Higher Power becomes precious and meaningful.Continue Reading...
“Thoroughly unprepared, we take the step into the afternoon of life. Worse still, we take this step with the false presupposition that our truths and our ideals will serve us as hitherto. But we cannot live the afternoon of life according to the program of life’s morning, for what was great in the morning will be little at evening and what in the morning was true, at evening will have become a lie.”
-Carl Gustav Jung
Home is, ultimately, that place where we find the peace and harmony that comes from learning to live with the knowledge of our imperfections and from learning to accept the imperfections of other; Such a place, such a home, can exist in various settings, but its ultimate foundation rests jointly within self and within some group of trusted others. Some places are more conducive to this experience: than others. But wherever and whenever we do attain that sense-”being-at-home”, we experience a falling away of tensions, a degree of balance between the pushing and pulling forces of our lives. In such a place we can cease fighting-most important, we can cease fighting with ourselves. We find the space to be the imperfect beings that we are, and we discover that in such a space, we also become able to let others be who they are.
Scholars have found in this experience of home-the longing and the searching for it-a sensitivity exquisitely developed in most alcoholics. The desire to be comfortable and just “fit in”.
We see so much about addiction in the media and on TV, but many people have a lot of questions about sobriety, what it means and how it will change their lives. Here some answers anyone ready for a change needs to know.
What Is The Point of Sobriety?
Survival. It is a medical fact that long-term alcoholism will result in a shorter more painful life, not just for the abuser but also for those closest to him/her. The point of sobriety is ‘life over death’. Addiction is a chronic progressive disease that, if untreated, will end in death.
What Is Sobriety?
Sobriety is described as the absence of mood altering substances: alcohol, narcotic drugs, pot, non-prescribed pain killers, etc.
What Is The Difference Between Sobriety And Recovery?
We can achieve sobriety by self-willed abstinence. In abstinence we may be successful for short periods of time or indefinitely. The easier and undisciplined way, which is abstinence only, affords a less stressful lack of commitment. It does not involve much self-awareness or inner change.
Recovery is a planned change of lifestyle designed not only to prolong life, but also make it more joyous and free. If the point of sobriety is recovery; then we can have a quality of life with more enjoyment, better relationships, less expectations, more acceptance and tolerance
Questions To Answer When Making A Recovery Plan
We need to know some basic facts before working with a client as a Recovery Coach, the same facts suggested by The Bridge, a publication of the Addiction Treatment Technology Centers. These facts should be used to ascertain a plan, which the client will write him/herself based on what they have revealed about themselves and other facts of their lifestyle the RC must learn from them:
1. Full substance abuse history as well as current use
2. Age, gender, marital status, partner status (sexual activity) and educational status
3. Occupation & Financial Status
4. Culture & Ethnicity
5. Medical, Psychiatric, Psychology and treatment history
6. Self knowledge of substance abuse
7. Readiness and Motivation
8. Spiritual or Religious beliefs and activity
9. Personal-finances, job, housing, family, support
Are There Alternatives to 12-Step Programs?
Yes. Some people are not comfortable in the beginning of their recovery journey with the 12-step approach, but may come to it later on in recovery. Those who dislike the AA approach are especially vulnerable to relapse, as there may to be no other place to go for ongoing support. But alternatives do exist and include the following:
- Self-Management and Recovery Training (SMART)
- A women’s group called WFS
- SOS a self help program that does not include spirituality
- Life Ring
- Moderation Management
- Online Meeting
There are many ways to change your life, but certain basic skills and patterns of behavior need to be learned for any of them to be successful. Most addicts don’t have those skills, or have not used them in so long that they need someone like a Recovery Coach, especially if they don’t go to AA meetings, to get them back on track.Continue Reading...
Meditation was daunting at first because I had to be perfect. Then when I tried my mind would wonder and I was sure I wasn’t doing it right, so I became exasperated. The 11th Step explicitly stated that prayer and meditation had to be part of my life. I was frustrated and fearful that if I didn’t get it right I would never achieve what others in recovery had, and I wanted it.
Discussions with my sponsor assured that I could do it, that it wasn’t as complicated as I was making it and maybe try KISS (Keep It Simple Stupid).
Relief. It didn’t have to be perfect!
Easy Steps to start meditating
1. BREATH Close your eyes and breathe through your nostrils slowly and gently, concentrating on each breath
2. MANTRA Find a word or phrase that images peace and tranquility. Repeat with each breath and keep it simple.
3. CLARITY Outside thoughts or feelings will enter your mind, softly push them aside and continue with your meditation.
Try doing it regularly, the investment will promote your healing and recovery. It is a process and discipline of repetition. It doesn’t have to be perfect and it doesn’t have to be for any set period of time. You may only do 5 minutes or less at first, but let it evolve and follow it wherever it takes you. You can do it anytime; pause during a stressful moment and do it to help you find peace.
A mantra can be any word from any source that relaxes you and helps you focus on the path of your spiritual journey. And you can change it anytime you want. It can be English, Spanish, Indian, Hebrew or whatever speaks to you. The word Om is used by many, stretched into a long chant. I use the Hebrew greeting and word for Peace, Shalom.
The noise in your head will get quieter the more often you meditate. You can bring it into your meditation to help quiet it. Let it be.
It is a scientific fact that any amount of meditation every day is better than none. There are mental and physical health benefits. Take a break. Try it.Continue Reading...
The disease of alcoholism is a gradual deteriorative affliction that devastates entire families and will continue to do so unless the alcoholic member takes action to live a life of sobriety, physically and mentally. It affects the person who is addicted to alcohol, that person’s family and everyone who interacts with that person.
Consider the following:
• Alcohol dependence and abuse cost the US approximately $220 billion in 2005. For the sake of comparison, this was greater than the amount of money spent to combat cancer ($196 billion) and obesity ($133 billion).
• An estimated 43% of US adults have had someone related to them who is presently, or was, an alcoholic.
• 6.6 million Minors in the US live with an alcoholic mother or father.
• About 14 million US residents battle an alcohol addiction.
• Greater than 50% of grownups in the US have had knowledge of someone in their immediate family with an alcohol problem.
• Around a quarter of all children experience some form of alcoholism in their families before they turn 18
• 40% of alcoholism is passed down through the gene pool, while the other 60% stems from unknown circumstances.
• 500,000 US Children ages 9-12 are addicted to alcohol.
• Studies show that the offspring of alcoholics have a greater chance of becoming alcoholics themselves than those whose parents are clean.
In the book Alcoholics Anonymous Chapter 2, There Is A Solution, It says:
“But the ex-problem drinker who has found this solu¬tion, who is properly armed with facts about himself, can generally win the entire confidence of another al¬coholic in a few hours. Until such an understanding is reached, little or nothing can be accomplished.”
Furthermore it says,” helping others is the foundation of our recovery.” And in the 12 Steps of recovery it says “… we tried to carry this message to other alcoholics and practice these principles in all of our affairs.”
If our primary purpose is to stay sober and help other alcoholics to achieve sobriety. Then I believe it is incumbent on me to carry the message of hope in writing as well as in meetings. From the depths of my heart there is an intuitiveness that inspires me to share what I have to come to believe as the result of the 12 Steps and our book, Alcoholics Anonymous.
The enormity of the problems alcoholics experience, both physically and mentally, and the quantity of human beings who have this disease has grown significantly over the last decade. As we understand more about it and learn the devastating long-term effect on the family as well, it is more urgent to get the message to as many as possible. Not only, that “There Is A Solution”, but that no one is better suited the help an alcoholic with recovery than another alcoholic. If we are to arrest this disease and prevent it from further debilitation of our families we must take action. We can stop the spread of alcoholism within our own families. It can end with us. What greater gift could we give our children?
The story of my life and my 45 years of alcohol and drug abuse, how I recovered and what my life is like now is intended to help others recover. It is an illustration that we can end this debilitating disease’s devastation of our families. We have a choice and an opportunity to ensure that our children are healthy and that they and their children can live happy, free and joyous lives.
The solution is multi-faceted and starts with carrying this message to the sick and suffering alcoholic no matter where he/she is, nothing has a more profound affect than one alcoholic talking to another about our problems with this disease. Family members, law enforcement persons, doctors, clergy and counselors can appeal to us and try to reason with us about the devastating consequences of our actions, but with little success. The experience, strength and hope of another alcoholic can start a path to recovery better than any other means.
My story is one of hope. It starts with how my defects of character developed within me, how I used alcohol and drugs to numb the pain, how my life was unmanageable and my powerlessness of addiction. The solution I found in the 12 Steps of Alcoholics Anonymous is a story that anyone who wants to change their life and become useful productive members of their community can follow and succeed.
The elimination of my drinking has only been a beginning; the relationship and partnership with my spouse, the participating in my children’s lives and my contributions to my community has changed my life.
It is my belief that the retelling of our experiences, what we have leaned from them and how we have changed our lives in recovery is key to helping others. What I am about to do is share “how I became what I used to be like, what I used to be like, what happened, and what I am like now”
As Allen Reid McGinnis said, “I can tell you things that I have come to believe with every fiber of my being, and you can dis¬agree with every syllable I utter, and yet both of us can be sober…both of us can be useful, productive mem¬bers, not only of Alcoholics Anonymous, but of society. So, if anything I say bothers you, just dismiss it. If any¬thing I say you disagree with, you’re entitled to disagree. “Nobody speaks officially for the Fellowship of Alcoholics Anonymous, not even the founders.”Continue Reading...
By Sarah Peters
New data linking severe mental illness and substance use could lead to more effective and streamlined treatment options for clinicians and patients, according to a leading expert in psychiatry and addiction issues.
The Washington University School of Medicine St. Louis and the University of Southern California jointly conducted a study of nearly 20,000 individuals, 9,142 of which were diagnosed with severe psychotic illnesses, collected over a five-year period. The findings were published online earlier this month in JAMA Psychiatry.
“What we are learning is that this overlap of mental illness with addictive disorders is not random,” said the National Institute on Drug Abuse Deputy Director Wilson Compton. The organization, part of the National Institute for Heath, provided the funding for the study.
Researchers looked at the nicotine, alcohol, marijuana and recreational drug use in mentally healthy test subjects and psychiatric patients diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. The study found that 30 percent of those with a severe mental illness engaged in binge drinking (four servings of alcohol or more), compared to 8 percent in the mentally healthy population.
The results for smoking and marijuana were much higher. More than 75 percent of those with severe mental illness were heavy smokers and 50 percent were heavy marijuana users. In the mentally healthy population, only 33 percent were heavy smokers and 18 percent were heavy marijuana users. While it is not yet known why the simultaneous occurrence exists, Compton said the findings do much in the way of helping both patients and doctors.
“We can use the fact that [mental illness and addictive disorders] go together to better reorganize our treatment centers to both address the mental illness and the substance issues,” he explained.
Clinicians have long suspected the co-occurrence of mental illness and substance use and even documented comorbidity—the concurrence of two disorders in one individual—in past studies. However, Compton described these new findings as a “wake-up call.”
“This kind of work is particularly important for the psychiatric community and treating clinicians,” Compton said. “For far too long psychiatry has ignored the problems related to substances while they focused on the mental illness of their patients.”
Establishing what causes simultaneously occurring disorders or determining if one caused the other has eluded clinicians thus far for several reasons. One reason being that some drugs have side effects, such as hallucinogens, that can cause symptoms similar to that experienced in a psychotic illness, according to the NIDA website.
Further complicating the issue is that drugs are often prescribed to treat severe mental illnesses.
“Mental illnesses can lead to drug abuse,” according to the NIDA website. “Individuals with overt, mild, or even subclinical mental disorders may abuse drugs as a form of self-medication. For example, the use of tobacco products by patients with schizophrenia is believed to lessen the symptoms of the disease and improve cognition.”
Although the cause behind the link remains a mystery, the importance of documenting the existence of this link with hard data should not be underestimated.
“Putting this on the radar as such a huge problem in this population of people with severe mental illness will help us both with the clinical treatment of the comorbidity and it will also help us researchers begin to understand the overlap,” lead author for the article and Washington University researcher Sarah Hartz said.
The results from the study conclusively show with hard data that mental illness and substance use need to be studied and treated together, not as individual ailments, she said.
The study was a first of its kind due in part because of its size—finding nearly 10,000 psychiatric patients with severe psychotic illness was no small task—and secondly because an overwhelming majority of the sample group agreed to allow researchers to re-contact them for future studies.
Past studies had been completed with individuals diagnosed with milder cases of mental illnesses, but this new study confirmed that rates of substance use in those with severe mental illnesses is much higher than previously assumed, according to the article.
Researchers are now planning a second, more intensely focused study of 2,500 of the original research participants diagnosed with schizophrenia to further examine the role of genetics in comorbid illnesses.
“My patients come to me all the time and ask, ‘what can I do about it if it’s already written in my genes?’” USC researcher on the study Michelle Paton said. “I tell them, this is not about destiny; this is about risk. The better we understand what risks you have, the more appropriate treatment we can offer when you come to us.” If funding for the next study is secured, researchers will begin as early as March, Paton said.
Fully understanding the relationship between mental illness and substance use is particularly important when considering past studies on the mortality and causes of death in those afflicted by severe mental illness.
On average, persons with severe mental illness die as much as 25 years younger than the general population, Hartz said. “I think it is part of the stigma of mental illness that people in the general population think [the mentally ill] have a crazy, hard life and they die because they did something dangerous and that’s not true. [The mentally ill] die of the same things we all die of but they die much earlier due to substance use.”
Preventable medical illnesses, such as lung and cardiovascular disease or cancer attributed to cigarette smoking or heavy alcohol use, are a leading cause of premature death in those with severe mental illnesses. While anti-smoking campaigns have significantly reduced illnesses related to smoking in the general population, these efforts seemed to have missed society’s more vulnerable population, Hartz said.
Part of this is due to a misguided belief that forcing a person to quit smoking or another addictive behavior while undergoing treatment for their mental illness could further damage the person’s mental health.
“When people come in for severe mental illness, we need to also treat the substance abuse,” Hartz sad. “We can’t treat them independent from each other.”
Hartz added that the responsibility to inform patients falls back on the clinicians. “Clinicians need to have a frank discussion about how important it is to quit substance use and how quitting a substance won’t destabilize [the patient] psychiatrically,” Hartz said. “Aggressively talk to your patients. The first step and the most important step is to plant the seed.”
This dialogue between patients and doctors may be of particular importance in gender and ethnic sub-groups that typically have lower rates of substance use. “The most striking finding of this study was the evidence that societal-level protective effects do not extend to individuals with severe mental illness,” according to the published article.
Findings in the study showed that participants of Hispanic and Asian decent, who typically have lower rates of substance use in the general population compared to that of Caucasians, did not benefit from any protective effect.
The same was found true for women compared to men, where women usually have lower rates of substance use. “The protective effects of belonging to these groups did not carry over to individuals with severe psychotic disorder: the odds of substance use increased to mitigate the protective effects,” according to the article. “…This highlights the need for targeting substance use specifically among individuals with severe psychotic illness because protective influences may not carry over from the general population.”
Researchers don’t yet know why severe mental illness seems to be a great nullifier. “Could it be that a severe mental illness alienates you from your group?,” Hartz wondered. “Could it be that either the use of substances helps cause the mental illness—which then takes away the protective factor—or that developing a mental illness takes you away from your peer group, making you vulnerable?”
Whatever the answer, researchers now have a concrete start provided by the new data and a launching pad for future studies.
“The numbers speak louder than assumptions,” Paton said. “This study was to show people how important it is to justify assumptions with data. The striking thing in this study, we didn’t expect the numbers to be so powerful.”
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