Alcoholism and Addiction

Alcoholism and Addiction

A significant percentage of my practice is comprised of individuals struggling with alcoholism and addiction. For most of these individuals, shame and guilt are pervasive, chronic, and destructive.  Many individuals struggling with alcoholism and addiction are blamed by others and/or themselves for their lack of motivation and willpower.  Unfortunately, the addictive process is much more complex than willpower and motivation alone.

An important part of the therapy I provide is increasing awareness and knowledge of the ways, in which, alcohol and drugs affect the brain.  When working with individuals struggling with alcoholism and addiction, I provide a gross oversimplification of the neurophysiological aspects of alcoholism and addiction.  I educate my clients about three different parts of the brain, the brainstem, sometimes referred to as the reptilian brain, the limbic system, also known as the mammalian brain, and the neocortex, aka the newest brain.

The brain stem is a knob of neural tissue sitting atop the spinal cord that controls breathing, swallowing, heartbeat, etc. (things that do not require consciousness). This is where we have our fight, flight, and freeze responses.  Damage to this area results in death

The limbic brain is located over the brain stem and contains all the emotional and social generating aspects that allow for genuine attachments and feelings to occur.  Damage to this area of the brain affects our emotions and abilities to attach to others.   This part of the brain does not deal in reason or logic.  For instance, we cannot direct our emotional lives, as we can our motor system to reach for a cup.  If we are feeling so sad, it is not possible to will ourselves to be happy.  This mid-brain area is also where our reward system is located.  Our brains are so sophisticated that they are actually hard-wired (reward system) to ensure that we will repeat life sustaining activities, such as, eating, drinking, procreation, attachments, relationships.  What happens in our brains when engaged in any of the above, is that dopamine (a neurotransmitter involved with feelings of pleasure, euphoria, motivation) among other neurotransmitters, is released, which on a non-conscious level informs our brains that this activity is important, must be remembered, and most importantly repeated.  The result is that we are drawn automatically, unconsciously towards these natural rewards, as our brains equate these things with survival.   The reward system is important to understand, as this is the system that drugs of abuse exploit and why cravings occur.

The neocortex is the seat of consciousnesses and of complex cognitive processes like perception, reasoning, abstract problem solving, learning, decision making and motor control.  When we are emotionally regulated, this part of the brain is able to function efficiently and effectively.  If we become dysregulated, which involves the limbic brain, the neocortex is impaired in functioning (i.e. Logic may go out the window, consequences do not matter, will power is compromised).    Research states that the limbic region of the brain is the one that calls the shots and that the entire neocortex continues to be regulated from the paralibimbic regions from which it evolved (Lewis, Amini, & Lannon, 2000).

Alcohol and drugs enter the picture as they target the reward system in the limbic brain and cause unnatural amounts of dopamine to be released.   Dopamine is the neurotransmitter of salience (signaling survival importance and reward prediction), which is why food, sex, relationships, and quenching thirst are all dopamine releasing behaviors.  However, these natural rewards produce 1-½ times the normal baseline of dopamine, while some drugs can produce up to 10 times (amphetamines) the normal baseline, alcohol (2 times) cocaine 3.5 times, nicotine 2.5 times.  This may result in alcoholism and addiction, as the user is driven on a non-conscious level to continue drug seeking and using.  The user’s brain has now associated the drug with survival.

Unnatural spikes in dopamine raise the pleasure threshold, meaning that activities that were once reinforcing or pleasurable no longer even register, hence we are unmotivated to do those things.  To complicate matters, our brains do not tolerate unnatural amounts of dopamine, so the brain actually decreases the dopamine available via decreased synthesis, decreased receptor sites and increased reuptake enzymes.  The result is that less dopamine is available, making it difficult for the user to experience any pleasure in life, unless he/she is using.  Eventually, even taking drugs will not result in the user feeling pleasure, however, the drugs is needed to prevent painful withdrawal symptoms and just to feel okay.  In addition to dopamine alterations, serotonin and opioids in the brain are decreased, resulting in anhedonia, compulsivity, perseveration, pain, depression, etc.

Alcoholism and addiction cause an extreme state of stress in the brain, which triggers the stress aversion system in the brain.  When the brain is under stress it releases corticotropin-releasing factor
(CRF), which unconsciously signals the user to seek out the reward system to cancel out the stress system.  Since the pleasure threshold in the reward system has been altered, natural rewards will not suffice, motivating the user to take the drug to experience pleasure and respite from stress.  Taking the drug provides initial relief, but again is stressful to the brain and so the cycle continues.  Continued drug use produces a chronically over stimulated stress response.

The above information provides a simplistic explanation regarding brain functioning in individuals suffering from alcoholism and addiction.  The intent was not to provide a comprehensive account of the neurophysiology involved, but rather to help decrease shame and guilt in those who feel that their lack of morality and willpower are their Achilles heel.

Why is Food Addictive

Why is Food Addictive

I  provide therapy to patients who are dealing with eating disorders such as Anorexia, Bulimia, and Binge Eating Disorder, as well as disordered eating styles that do not meet criteria for an eating disorder.  These are serious conditions that wreak havoc on patients by affecting their sense of self, their health, their relationships, and their well being.  All of which ultimately diminish one’s ability to participate fully in daily activities.

After a general medical condition has been ruled out, I work with patients in therapy to determine the underlying psychological and emotional causes for their condition.  In addition to the underlying factors contributing to one’s eating disorder, they also serve as powerful coping mechanisms. We associate food with memories, use it to make ourselves feel happy when we are sad, rely on it as a way of showing love for our families, and sometimes even punish ourselves with it. My goal is to help patients understand why they interact with food the way they do, so that we can work together to build a life that doesn’t revolve around food.

Understanding Food Addiction

It can be helpful to understand why food is so addictive in the first place.  Research has shown that the same pleasure and reward centers of the brain that are triggered by addictive drugs like heroin and cocaine are also activated by food.

Highly palatable foods that are rich in sugar, fat, and salt trigger the release of brain chemicals, like dopamine, that just make you feel good. For some individuals, the neurochemical structure of their brains may predispose them to either being more sensitive to the chemicals released when eating highly palatable foods or less responsive, meaning it takes eating more of the food to elicit the same pleasure response.    Over time, this can override normal feelings of satisfaction, induce cravings, and compel you to eat, even if you’re not hungry. Tolerance can build and despite more food being consumed, the same pleasurable effect is harder to achieve.  Once food addiction occurs, eating becomes the primary source of pleasure and reward and the individual is less motivated to engage in other activities that were once appealing.

Signs of Food Addiction

It may be difficult to admit to yourself that you have a food addiction, and it can also be hard to identify in others, as there is a significant amount of shame and secrecy around food addiction. Below are some questions that may help identify in an addiction is present.

  • Does it often feel like you are eating more than you planned, especially when it comes to certain foods?
  • Do you feel the need to continue eating those foods, even though you are not hungry any longer?
  • How often do you eat so much that you become ill?
  • If a certain type of food is not available, what actions do you take?
  • Is eating interfering with your ability to work or interact with others?
  • Are you embarrassed by how much you eat around others?
  • Do you eat in secrecy?
  • If you try to cut down, do you experience anxiety, agitation, or any other physical symptoms?
  • Have your eating habits caused you to experience depression, self-hatred, or guilt?
  • Does it feel like to need to eat more and more just to feel any pleasure at all?

Food addiction may not look the same for everyone. These questions don’t necessarily indicate that you have or don’t have an addiction, but they can be helpful guidelines. If you think there is cause for concern it is always best to check with a medical doctor and a mental health professional.

Getting Help for a Food Addiction

Once a person becomes addicted to food, it is difficult to stop, despite any rational thinking or negative consequences that occur. It may require medical care, treatment for depression, nutritional counseling and physical training combined. Here are a few organizations which can provide further insights into the causes, symptoms, and treatments for food addictions:

  1. National Association of Anorexia Nervosa and Associated Disorders (ANAD): This non-profit organization has been dedicated to the prevention and alleviation of eating disorders since 1976. ANAD advocates for the development of healthy attitudes, bodies, and behaviors. The organization also promotes eating disorder awareness, prevention and recovery through supporting, educating, and connecting individuals, families and professionals.
  2. National Eating Disorders Association (NEDA): NEDA was formed in 2001 through the merger of two groups – Eating Disorders Awareness & Prevention (EDAP) and the American Anorexia Bulimia Association (AABA). NEDA believes we can confront eating disorders with increased awareness, early intervention and improved access to treatment. The non-profit provides programs and services to give families the support they need to find answers for these life-threatening illnesses.
  3. The Something Fishy Website on Eating Disorders: This website has been raising awareness and providing support to people with eating disorders and their loved ones since 1995.  They are determined to remind every sufferer that they are not alone, and that complete recovery is possible.

If you or a loved one is affected by a food addiction or an eating disorder, contact my office immediately to set up a session, and let me help you find a path to a better life.

Dr. Adina McGarr-Knabke
 

 

 

 

 

Pain Inevitable Suffering Optional

Pain Inevitable Suffering Optional

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” —Viktor Frankl

In Man’s Search for Meaning, Dr. Frankl wrote about the psychological impacts of life as a prisoner in the Nazi concentration camps of World War II. His mother, father, brother, and pregnant wife were all killed in the camps. Dr. Frankl describes in chilling detail how his captors took from him virtually everything of personal value and basic human dignity. The only thing that the Nazis were unable to take away was his choice as to how to respond to the deprivation, degradation, and trauma to which he was subjected. He made a conscious decision to focus his energies on “owning” that small but all-important space between the stimulus (whatever was said or done to him) and his response to it. His ability to retain that degree of psycho-spiritual autonomy in the most horrific circumstances imaginable provides a remarkable example of intrapersonal strength, grace under extreme duress, the power of personal choice, and the Serenity Prayer in action.

Physical pain has distinct biological and psychological components that effectively represent stimulus and response. The biology of pain is the signal transmitted through the central nervous system that “something is wrong.” The psychology of pain is the interpretation or meaning we give to that pain signal—the internal self-talk and beliefs about it which then drive our emotional reactions. Suffering results from mental and emotional responses to pain. The biological and psychological facets of chronic pain combine to become like a smoke detector that goes on and stays on, continuously sounding a harrowing alarm at high volume. Recovery from chronic pain distinguishes between the actual pain and the suffering it causes, and focuses on achieving relief from that suffering. Pain is unavoidable; suffering is not. It occurs in response to thoughts such as: “Why me?!” “It isn’t fair!” “This is horrible!” “I can’t stand it!”

Suffering in general, as well as specific to chronic pain, is a function of imbalances in physical, mental, emotional, and/or spiritual functioning. Because whatever affects the mind or the body will inevitably affect the other, regardless of which side of the fence an issue originates, imbalances in thinking can create imbalances in physical, emotional, and spiritual functioning. Recovery—from any significant condition or life challenge—is a gradual, progressive, and ongoing process of restoring balance in these areas.

Suffering is both a cause and an effect of the catastrophic cognitions and distressing emotions associated with chronic pain: anxiety, irritability, anger, fear, depression, frustration, guilt, shame, loneliness, hopelessness, and helplessness. Negative thinking only makes situations we believe to be “bad,” worse. Many people, including those who do not suffer from chronic pain, can ruminate on something by continuously and unproductively replaying it in their minds or magnify the negative aspects of it. Our thoughts have the capacity to make us miserable, and negative thinking can be especially insidious, feeding on itself, with the potential to become a self-fulfilling and self-defeating prophesy.

For people with chronic pain, there is a direct correlation between negative thinking and the level of pain they experience. It’s a vicious circle wherein pain triggers negative thoughts and self-talk which translate to feelings that coincide with suffering, and increases muscle tension and stress, which in turn, amplify the pain signals, triggering more of them. The progression is essentially as follows: pain leads to negative thoughts/self-talk/beliefs lead to feelings of frustration/anger/anxiety/fear/sadness/depression /hopelessness lead to suffering leads to muscle tension and stress lead to more pain leads to increased negative thoughts/self-talk/beliefs lead to increased frustration/anger/anxiety/fear/sadness/depression/hopelessness leads to greater suffering, and so on. The longer such a cycle continues, the more out of balance a person becomes.

Suffering can be modified when people become consciously aware of this chain reaction and learn how to respond differently to their pain. The process of pain recovery includes dramatically changing the negative progression starting with regaining cognitive and emotional balance through the application of acceptance strategies and mindfulness-based practices. Reestablishing balance counteracts the above deviation-amplifying dynamics: conscious awareness of negative thinking/self-talk and how it sets off the cascade of events that fuels suffering leads to mindful acceptance and detached observation of negative thinking/self-talk lead to tamping down/minimizing of suffering leads to decreased feelings of frustration/anger/anxiety/fear/sadness/depression/hopelessness lead to lower stress and muscle tension leads to less pain.

Is this easy? Of course not. However, it is absolutely possible. By adjusting our thinking, and how we think about our thinking, we can change our emotional responses, the extent to which we suffer (or not), our level of tension and stress, and in turn, our experience of pain.

Source: Psychology Today – Dan Mager, MSW Published on January 13, 2014

Do Compulsive Overeaters Have a Food Addiction ?

Do Compulsive Overeaters Have a Food Addiction ?

People who are compulsive eaters show similar activity in the same brain regions as people who are addicted to drugs or alcohol. Addiction to food is a biologically driven process linked with reward centres, and not just another behaviour problem. Forty-eight healthy young American women with body sizes ranging from lean to obese were first tested with the Yale Food Addiction Scale and then monitored with functional magnetic resonance imaging (fMRI). Each woman was first shown a picture of a chocolate milkshake and an image of a glass of water. They were then asked to actually taste the milkshake (milk with four scoops of vanilla ice cream and 2 tablespoons of chocolate syrup) or a solution which tasted like natural saliva (plain water would have activated parts of the brain related to taste).

The researchers chose milkshakes not only because they have a high fat and sugar content (sugar has been most consistently linked with food addiction), but also because they could be consumed relatively smoothly through a small tube in the mouth. In contrast, chewing associated with candy bars or other forms of sweets would have caused the participants to move their head during the scan. One hypothesis was borne out almost immediately: Women with higher food-addiction scores showed more activity in the parts of the brain associated with addiction when exposed to pictures of delectable chocolate milkshakes.

But, unexpectedly, when sampling the actual food, women showed less activation, which could be because the brain just gets flooded all the time, which shuts down some of reward reactors. This could be due to their hope of it being the best thing they ever tasted but when it doesn’t meet expectations, they eat more.

The researchers noted that obesity-related disease is the second leading cause of preventable death. They also explained that further research was necessary to clarify their results, pointing out, for example, that their study did not measure hunger (which could have an impact on the scores) and was confined only to females. Despite some limitations, the researchers felt the specific nerve patterns of brain activation in some subjects suggested addiction, and were especially worried by the finding that mere images of food could start the brain racing.

Advertising is everywhere and exerts a powerful influence over our behaviour. But it can have a positive impact, too, by helping people develop more successful self-control strategies, modulate food cravings and make healthier choices. Another concern was that about 10 percent of people who didn’t necessarily qualify as food addicts also showed some activation in the related brain regions. Even though a small percentage might be full-blown food addicts, some may be having only symptoms like a lot of cravings.

The researchers hope that this study could help the scientific community to accept food addiction as a disease, thereby reduce stigma among heavier people and more effective ways for them to lose weight.

Read more at: Compulsive eaters have food addiction
Archives of General Psychiatry, 2011

Gambling Addiction

Ludomania, more commonly known as, compulsive or problem gambling is an addictive behavior, in which an individual is preoccupied with gambling and continues to engage in this behavior, despite a desire to stop and/or adverse, negative consequences.  As with other forms of addiction, the gambler develops tolerance and requires more of the gambling behavior to experience the same type of rush.  The individual commonly experiences a loss of control and frequently lies and/or engages in illegal activity to continue his/her habit.  In addition to severe financial consequences, social, occupational, and psychological functioning are significantly compromised. 

Compulsive gambling is considered an impulse control disorder, therefore the American Psychological Association does not recognize it as an addiction.  However, as described above, it shares many common characteristics evidenced in other addictions and responds positively to 12-step programs, popular with substance abuse disorders and eating disorders.
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Shopping Addiction

Compulsive shopping, lesser known as omniomania, is a behavioral addiction, where shopping becomes the individual’s primary coping mechanism, pursued to excess, despite negative associated consequences.  Social, financial, and occupational functioning is significantly impacted, yet the addict feels helpless to control his/her behavior. 

Onset typically is in early adulthood, but can occur in the late teens.  The prevalence of this addiction is thought to be approximately 8.9% of the U.S. population (Ridgway, et al., 2008).  This disorder commonly co-occurs with other addictions such as, substance abuse, eating disorders, personality disorders, and impulse control disorders.

Similar to other addictions, the shopping addict is often consumed by thoughts, plans, rituals, and trips devoted to the act of shopping.  Engaging in this behavior brings relief and feelings of pleasure.  These feelings, however, are only transient and the addict soon needs to re-engage in the behavior, in what becomes a never ending cycle.