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Addictions Anonymous, 6: Triggers

 article about addiction triggers

This article belongs to Addictions Anonymous column.


What addicts do involves either a substance such as alcohol or a behavior like gambling, but that's just the surface. Addicts often describe themselves as crazy; non-addicts look on in horror and agree. Once again, however, let's listen to what the addict is saying and admit they could be at least partly right because an addiction can be defined as a state of mind, and not usually a happy one at that.

I'll be using the term dark feelings as short hand for the emotional soup in which addictions grow; more about all that later. The addiction makes this bad thing—dark feelings—worse over time by undermining beliefs, values and the ability to reason. Although we don't like to admit it, addictions are mental disorders if not medical diseases. An addicted state of mind is far more disabling than most people want to admit, especially for the person who happens to own the mind in question.

 article about addiction triggers
With long experience, a person gets used to how one is even if how one is would not be described as a voluntary or happy existence. Even dark feelings can come to be a kind of security blanket, something that gives permission to do weird things in an effort to make these feelings go away for a little while. There is always resistance in making changes in how we think because many of our thoughts are like comfortable old furniture; the springs are busted and the padding is hanging out, but they're ours and we trust them to hold us up, at least for a little while longer. One gets used to a certain mental landscape. New thoughts or ideas can be very scary.

Research on the human brain shows that addictions can be defined in terms of brain chemistry. Those advances, however, will not end our search for causes since scientists will next have to find out how chemistry, genetics and experience all work together to set the stage for addiction. They will have to explain how some people with the same personal characteristics as addicts manage to avoid addiction. Even with respect to genetics, many who share a family history differ in their susceptibility to addictions. If we had some magic bullet from medicine to stop the craving, once the addiction is put away we would still have to learn new and sometimes uncomfortable ways of thinking and acting. While we wait for the imaginary magic bullet to do the job for us, we can and should do something to change our thinking—to change our minds, if you will. And changing a mind is one of the hardest things in the world to do, especially if it's your own mind that needs changing. This is where programs such as the Alcoholics Anonymous Twelve Steps work their benefits; they offer the ideas, concepts and values that are so necessary in the mind changing business.

The list of possible addictive agents and activities is long, and seems to grow longer every year. We seem to be devoted to inventing or discovering new addictions. Over the years Alcoholics Anonymous inspired such off-shoots as Overeaters Anonymous, Gamblers Anonymous, Narcotics Anonymous, Emotions Anonymous, Sex and Love Anonymous, etc. The multitude of different Twelve Step groups is interesting and their very existence yields insight into the nature of addiction itself.

Psychologists love to snoop around and walk in the minds of others. We're generally pretty harmless, sometimes even helpful. Some years ago, at the Nevada Veterans Administration Medical Center in Reno, Nevada where I was Chief of the Addictive Disorders Treatment Program, we developed a measure of overall addictive activity; it was really just a simple list of all the different possible addictions our patients with drug, alcohol and gambling problems might have. People coming into our program usually were focused one only one addiction, the one thing that was causing the most pain in their lives, or at least the one thing they were willing to admit to. However, we treated all addictions in a single program as if each different addiction were but a sign of some underlying and more fundamental disorder.

When I came to work on the program it was called the Alcohol and Drug Treatment Program (A.D.T.P.). I renamed it the Addictive Disorders Treatment Program and we didn't have to change the lettering on the walls since we were still known as the ADTP. See, some government workers save the people money. Gradually, however, our behavior began to change as we became more alert to the possibility of important cross addictions. Our language began to mention addiction more often than alcoholism or any particular drug.

In the 1980s, the Reno V.A. was a small hospital that could devote only about ten beds to the Addictive Disorders Treatment Program, so there were practical and financial reasons to combine with larger hospitals that had separate programs with more bed space and different specialized staffing. But I also had fancy theoretical ideas, ideas that will be spelled out in as I go along.

As a sad footnote, after several years of admitting a full range of addictions, our ADTP was closed and addicts were no longer given inpatient treatment at the Reno V.A. Medical Center. Homeless and destitute veterans were turned away if they did not have severe medical problems, so I moved to another facility were inpatient treatment was still offered.

Below is the list of substances or activities about which we questioned our incoming veterans. We asked them to check any item that was a problem in the past six months of their lives, and we also asked them to check any items that had been a problem at any time in their lives.

A list of addictive agents and activities:

____ Cocaine

____ Heroin

____ Amphetamine or similar "pep" pills

____ Morphine or related opium-like drugs

____ Gambling for money

____Marijuana

____Pipe, cigar, cigarette, snuff or chewing tobacco

____Alcohol; beer, wine, liquor, whiskey, etc.

____ Barbiturates and similar sedative drugs

____ Hallucinogenic drugs (LSD, PCP, mescaline, etc.)

____Caffeine (tea, coffee, cola beverages, etc.)

____Stealing, shoplifting, petty theft, etc.

____Sugar-based foods (candy, baked goods, ice cream, etc.)

____Fatty, oily or greasy foods

____Salt from the shaker and/or salty foods

____Highly seasoned or spicy foods

____Spending just for the sake of spending

____Work for the sake of being busy

____Anger, fights and arguments

____Trying to manipulate and/or control other people

____Trying to get attention for attention's sake

____Reading for reading's sake

____Trying to get others to care for me and do things for me

____Exercise, jogging, playing sports or working out

____Seeking and having sex with another person

____Seeking and using pornography (sexually oriented pictures, books, etc.)

____Watching television

____Talking just to be talking

____Searching for, buying and collecting certain items

____Lying for no reason

____Aspirin or other non-prescription pain medications

____Controlled (prescription only) pain medications

____Laxatives

____Nasal decongestant sprays and inhalants

____Antihistamine pills or other decongestant pills

____Antacids and stomach remedies

____Fast and/or reckless driving (not including driving under the influence)

____Valium, Librium and related ‘minor tranquilizers ‘

____Physical violence

____Cough and/or cold medications

____Religious activity

If I were giving this survey today I would add: Internet surfing, computer games, burning, cutting or mutilating oneself and sun tanning.

Every one of the items on our list at one time or another was referred to as an addiction by some authority or by the popular press; society was using addiction to refer to an ever-longer list of substances or activities.

No one can predict how many different addictive patterns we will recognize in the future. As this is written, we have begun worrying about people who spend too much time on the electronic communications networks, i.e., the Internet. Listening to loud music and playing computer games have been suggested as possible addictions. However, in order for me to consider something to be an addiction it has to show more than just frequent use. If we use the term addiction carelessly for any frequent habit it will lose its meaning.

We do have one rather well established physical sign of addiction and that is endorphin release in the body. This chemical is responsible for feelings of relaxation, calm and anxiety relief. The items on my list, however, have not all been shown to be endorphin related. Many different patterns are used in arriving at a final conclusion.

If you personally don't have a certain problem, it may be very hard to understand how some activity can become a damaging addiction. However, the characteristic signs of addiction seem to hold for all of the items on the list although they are never exactly equal in prominence between addictions and between individuals. I use the word triggers to refer to the list of addictives above. It is as if a gun were already loaded and ready to fire, all it takes is someone or something to pull the trigger, and this is what the items on the list represent for certain vulnerable people.

The list of addictive triggers also reminds us of an important point about addictions: not all addictions are equally severe or damaging. Let's take the excessive use of salt and the love of salty foods as an example. A salt habit barely makes the grade as an addiction for most users, but if a heavy salt user is suddenly forbidden the use of salt because of heart problems and bloating, there will often be resentment and feelings of deprivation. Severe health problems can result from ignoring advice to cut back on salt. It is interesting to note the over use of salt may signal the presence of other, more severe addictions. If you know someone who is heavily into salt, check that person out and do a little psycho-sleuthing of your own. What else is going on? Salt enhances the taste of food, and therefore it is value as a comforter of dark feelings. Spicy, sweet or fatty foods do that for some people, too.

Addictions exist at all levels of severity from very mild and almost harmless to very severe and life damaging. Addictions, then, are never black and white. Some run in brief cycles while others get used only a few times during a month or year. Some are unnoticed and some are very prominent.

Here is how we know if something is an addiction for a certain individual:

1. Increased tolerance: The capacity and desire for use of the addictive increase to very high levels, levels that in some cases would represent a lethal dose for the non-addicted individual. The thinking here is that if some is good, more is better. There is also a physiological habituation in many cases.

2. Preoccupation: The addictive occupies an increasing and eventually dominate place in life with the person spending larges amounts of time, energy and often money to finance the activity.

3. Withdrawal and rebound: Attempted or enforced abstinence leads to psychological and often physical problems, referred to as a hangover by alcoholics.

4. Mood swings. As described in the following columns, emotions swing back and forth between elation and deep depression depending on the amount of use of an addictive and when it was last used.

5. Distortion of rational thinking: In an altered state induced by an addictive activity, or in the rebound phase following heavy use, thinking is altered, often in dangerous ways. The person does things he or she would never think of doing in a normal state of mind.

6. Substitution or compensation. The effect of reducing a favored addictive behavior is often accompanied by increases in the use of other addictives. When drinking, for example, is cut back, the person may smoke more, show hyperactivity or begin gambling. In consequence, what were once minor problems my suddenly emerge as major new addictions.

Use of a trigger or addictive does not by itself signal an addiction. Don't make the mistake of thinking that because you or someone you know has a certain addiction everybody who uses it is either addicted or susceptible to addiction. If you think that please go back and memorize the list of signs I just gave you. Resist the temptation to become the Paul Revere of laxatives or coffee. Crusaders are a pain in a bad place. The only person I can fix is me. You're no different, so don't become a prohibitionist, and don't over-extend the meaning of addiction without good evidence. Stick with the known signs of real addiction.



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