Tragically another music icon ends an incredibly creative life at age 27. Besides the uncanny fact that so many (10) incredibly talented musicians who died at 27, there is the other apparent truth that they all had everything their peers could have wanted. They were incredibly successful, had huge fan base, and were selling albums and tickets to concerts galore. What could possibly have gone wrong?
Ms. Winehouse said living dangerously generated her creativity, and she was often photographed half-dressed, wild-eyed and disheveled. The English tabloids reported she had suffered brain damage from excessive use of drugs and alcohol."
"Onstage, the more Amy Winehouse drinks, the better she sings, which is often the case. She's the hottest voice you've never heard -- her album hit No. 1 back home in England -- but right now, at her first U.S. concert, her nerves are bedeviling her. She makes awkward chitchat in that cockney twang. Tugs distractedly at her trademark ratty do. Yanks nervously on the strapless shift that's sliding dangerously south.
Finally, she requests an amaretto sour -- to hoots of approval. It's a part of her shtick, what her fans have come to expect."
We may never know exactly what led up to her death. An initial post-mortem proved inconclusive. A toxicology report is due within a few weeks. Her family insists that she'd quit drugs years before, and had recently quit alcohol. Family speculated that she may have had a withdrawal seizure or gone into shock.
There is no evidence that she was suffering from depression. In my experience however, depression is often a factor in drug or alcohol abuse. Artists have a unique ability to express their thoughts and feelings in their chosen media, in this case music. Songs of psychological pain are common, and certainly only a small number of authors are depressed or suicidal. Sadness and other negative feelings help color our world, help us appraise our environment, especially in novel situations or with unexpected elements.
Most of us can make some sense of our experiences and move on with new information with ourselves. Some however see negative feelings as evidence of a deeper problem in themselves or see them as signs of a flawed character. The misery of such knowledge without solution can lead a craving to escape it in self destructive ways. Drugs and alcohol is one of those methods.
Without help to find a way out, they may spiral downward into a self-image that is full of shame. Shame feeds the cycle of self-destructive escape and further misery until the trap seems inescapable. As symptoms worsen, concentration and focus deteriorates, relationships flounder, mood plummets until appetite disappears and even the escape of sleep is lost. Temporary escape becomes a preoccupation until it too fails to satisfy. Then, the only escape becomes self-destruction.
In simplistic terms, this describes how negative feelings and self-talk can lead to depression and perhaps even suicide.
It is truly tragic that so many of our most talented artists die so young. The stresses of being in the public eye with so much money on the line I'm sure are overwhelming. There is a tragic cost to fame and fortune. Perhaps more awareness of drug and alcohol abuse and depression will save lives in the future.
I quit smoking 28 years ago. The final effort started the previous year on "Great American Smokeout", 29 years ago. I'm very glad I succeeded.
I used to joke that quitting smoking was easy, I'd done it 100s of times. Unfortunately it was all too true. I struggled with attempts to quite smoking over most of my adult years. It's a major bad habit, with the further complication of addiction to Nicotine. At one time I smoked three packs a day. I was thoroughly hooked.
In my experience, I've found that major bad habits of all kinds are very difficult to break. Many a New Years' resolution has gone unfulfilled due to this problem. Despite our best intent and efforts, somehow all the logic in our arsenal cannot overcome an well established habit. That is because it has been "hard wired" into the body separate from our "thinking" brain.
Generally bad habits are conditioned by the effects they have on our body. Often they give us pleasure, a good feeling that we wish to have again. Almost all bad habits have some sort of "withdrawal" syndrome, if only a mild discomfort and increased anxiety. Drug and alcohol dependency is also a bad habit, but the withdrawal syndrome is much more serious. Alcohol withdrawal or DT's amounts to a medical emergency because the sufferer may die. Most other drug withdrawals aren't nearly as serious, but are none-the-less very uncomfortable for a prolonged period of time. But I've found that most people who are chemically dependent aren't concerned about the withdrawal, they are stuck on the pleasure effect. After a long term dependency, that sense of pleasure becomes a feeling of relief from all the complications of stopping the drug, not just the withdrawal.
Bad habits have one major attribute in common, they create a reward system unique to each user, adding to the feelings of pleasure, a personal reason for the habit. Most of the people I've worked with over the years, uses the bad habit to escape uncomfortable feelings like anxiety, guilt, shame, fear, or embarrassment. No one likes to feel these feelings. However, our pill popping culture has come to believe that negative feelings are a problem that needs to be avoided or even treated. Our culture teaches us we have a right to be happy, something we all work for, but find retaining that feeling for any great time quite elusive.
Even something as benign as biting one's fingernails can become excessive and escapist in it's effects. Some people bite and tear at their fingernails and cuticles until they bleed. At this point, this habit has become a form of self-injurious behavior.
I often tell my clients of my experience quitting cigarettes as an example of the sort of effort and persistence that's necessary.
As I approached my thirtieth birthday, I had been smoking 15 years. I had developed a serious cough. On top of that, every time I got an upper respiratory infection, it quickly advanced to bronchitis. I found my blood pressure became periodically very high, and then return to the high end of normal. The cough was persistent and annoying, but the bronchitis and the high blood pressure convinced me that smoking was going to kill me, sooner or later.
I decided I had to quit. I started that night, as soon as my pack of cigarettes was gone. My resolve lasted until noon the next day when I went to the store on my lunch break to buy another pack. I really wanted to quit, but I was finding it very hard to sustain the effort through a single day.
For the next few months I continued to quit many times when I ran out of cigarettes by the end of the day. And then I started again by noon the next day. The recognition of my failure and embarrassment stared at me everyday when I walked into the local convenience store. Finally, I recognized that I was not truly ready or motivated to take on this task. I fully intended to quit, but needed the kind of motivation or emotional fortitude to sustain the effort.
A few years later, my son's promised birth creating a reason. I decided I didn't want to expose my newborn son to cigarette smoke. I quit on the Great American Smokeout day, and managed to sustain the effort for a couple of months and I gave in again. After his birth, I went out of my way to smoke outside or in the basement to avoid exposing my son. The hassle of making the habit more inconvenient enabled me to cut back smoking significantly.
I started to notice other relatively minor annoyances of smoking. The habit is gross and the worst part of the habit for me was the appearance and smell of a dirty ash tray. The ash would hover in the air for several minutes after I emptied the ashtray. The smell was horrendous to me. It seemed to follow me from the kitchen.
That flu season was a bad one. I ended up with walking pneumonia. Part of that problem is that I'd switched to menthol cigarettes so I could tolerate smoking more while I had bronchitis. How pathetic is that? I was so sick, I couldn't smoke anymore. But as soon as I was feeling better, I was back at cigarettes, this time the menthol type with an even stronger addictive quality.
Eventually I faced the fact that quitting at the end of a pack of cigarettes created an opportunity to start again the next day. I decided to quit, this time in the middle of a pack of cigarettes. I kept that half empty pack next to the dirty ashtray and lighter, on the coffee table sitting next to my TV chair where I had smoked for many years.
Everyday, I'd sit down after work to watch the news. For awhile, everyday without a thought, I reached over, picked up that pack of cigarettes, pulled one out and went for my trusty lighter. Then it would dawn on me, I had quit. I stuffed the cigarette back in, put down the pack and the lighter. If I had any trouble doing so, I leaned over and took a good sniff of the dirty ashtray. That never failed to turn my stomach!
Eventually, I'd catch myself before I pulled the cigarette out of the pack, and put it down. Then I started to catch myself with the pack in my hand. Eventually, all I had to do was glance at the pack and I'd remember I'd quit. That pack and dirty ashtray sat there for over three months. Finally one day, I was upset, feeling particularly sorry for myself, and picked up that pack, pulled out a cigarette and lit it up. I took a long drag and started coughing. Anyone who has smoked for any great length of time knows just how bad a stale cigarette was. I stubbed out that cigarette, tossed the pack and cleaned the ashtray. I put my lighter in the bottom of a drawer. I never touched a cigarette again.
A bad habit can be broken. It takes sufficient determination, and some stop gap techniques to distract and remind you of the consequences. Some of those bad feelings that smoking used to relieve, actually became part of the cure!
Good luck to all those out there in a struggle with smoking or any bad habit.
I really enjoy reading the blog Kellevision.com. She says it like it is and seldom misses the point of what she's writing about. She identifies a problem in programming for homelessness and proposes a set of concepts to help clarify the situation.
"Many of the "barriers" faced by the chronically homeless are not external. They are self-inflicted. Repeatedly failing to pay one's utility bills is not a barrier. It is a behavior. Repeatedly getting into relationships with drug addicts and being evicted because you have allowed your new girlfriend to turn your affordable housing into a crack house is not a barrier. It is a behavior. Choosing to pay your boyfriend's bail instead of the rent is not a barrier, it is a behavior. Consistently refusing to hold down steady employment and being evicted for not being able to pay the rent is not a barrier, it is a behavior.
[..]Lastly, how we label the problem determines how we approach solving it. True social barriers need to be addressed by social services. Better programs need to be designed to specifically address the needs of the mentally ill population. Programs designed to assist the medically disabled need to be accessed. But behaviors require a clinical intervention - therapy. Clients who demonstrate patterns of behavior which result in repeated instances of homelessness need counseling, not social services. The problem is not a social problem. It is an individual problem which requires an individual intervention."
I think it's much more complicated than that. Our world has always had an underclass, a group of individuals who have been largely invisible in the US except during the Depression. These people largely function outside the visible society and economy. They share housing with family and friends, squat in abandoned buildings, and sometimes live under bridges. They live off their housemates or family, work for temp job agencies, borrow, steal, deal drugs, and even engage in formal criminal enterprise. Given our recent policies that have reversed the tax-based redistribution of wealth since FDR, the stagnant wages, disappearing jobs, and ever increasing cost of living, that underclass has become so large it is again visible.
They are chronically under or unemployment and are not collecting Social Security, either because they don't qualify, try though they may to apply, or they haven't the where-with-all to get themselves qualified. This chronic underclass is best described as a sub-culture. They are structurally built into the economy. "Full employment" doesn't include them. Because they have given up on finding work, they no longer register with unemployment offices and so are not counted among the unemployed. Those who are chronically homeless are a sub-group of this sub-culture, and probably represents some of its most dysfunctional members.
By describing the chronically homeless, Kellevision describes most of the common attributes of this subculture.
"For the majority of the [chronically] homeless population, homelessness is a lifestyle, not an event.
[..]My purpose here is not to blame the victim, but to talk openly about the severe dysfunction I see in chronically homeless families. Unless we identify the true problem, we will not be able to form a lucid solution. Homeless families typically do not function well on any level. Children are frequently truant from school and display numerous behavior and developmental problems. Dorm rules are constantly broken and there is constant turmoil between the families on the dorm. Relationships are fleeting, intense and severely dysfunctional including domestic violence, substance abuse and exploitative. Interactions with other people are inappropriate or dysfunctional. Most homeless families have burnt all their bridges with every social service agency and with their own families because of their severe dysfunction. Shelter staff often feel like we are running a middle school rather than a homeless shelter. This behavior is what needs to be addressed rather than giving them more money or building more homes.
[..]What are the elements of the homeless mindset? I'm still trying to work this out in my mind, but here are some of them which I see frequently:
An external locus of control
the belief that they have no control or responsibility for their choices, actions or behaviors but they are the victim of circumstances
the belief that the causes for good or bad events in your life are totally outside your control or responsibility
Sense of entitlement
the belief that the worlds owes them something and they should be able to collect immediately
the belief that they should be taken care of by others, by the government or by social service agencies
the belief that they should be given things they have not earned (i.e. free housing, clothing, food, etc.)
the belief that others should "help" them (i.e. by paying their unpaid bills or appealing their housing denial)
Impulsivity
Poor boundaries
Emotional immaturity
Need for instant gratification
Dependency issues
Predatory/antisocial behaviors
Pathological relationships
"
Certainly, not every member of what I'll call the "underclass sub-culture" share all of these attributes. Each and every person has a story behind their situation. A careful account of their histories, something they usually reluctantly give, chronicles the development of these problems. It's important to discourage a prejudice developing against a whole group of people who are already stigmatized along with the "welfare mother" of the AFDC era. But we are not going to get to a more complete solution without understanding the problem. I suspect that why there is little commentary on this topic.
Kellevision hits on what I believe to be one of the most common roots of dysfunction, repeated traumas throughout their life.
"A vast majority of our clients seem to have endured some sort of trauma(s) during their childhood which has(have) halted their emotional development. The result is immaturity, impulsivity, dependency, a sense of entitlement (that someone should take care of them rather than being responsible for themselves), an external locus of control (seeing problems as existing outside of themselves and therefore being outside of their control and/or responsibility), immature relationships and emotional lability. These factors result in behavior which appears erratic and irresponsible."
"Arrested development" is what Kellevision calls it. Indeed, this problem is pervasive and most often multi-generational. There are most often one or more of the following in the family history:
lifelong repeated exposure to trauma:
child abuse and neglect
incest
domestic assault
gang or drug related violence
repeated exposure as a crime victim including assault, rape, and drive by shootings
inconsistent parenting ranging from abusive to no supervision
one or more family member who was murdered
poor performance/attendance at school
high school drop-out
parenthood started by mid-teens
by their twenties, they have several kids with mostly different partners
sporadic work history and chronic unemployment
efforts to qualify for Social Security
family members relying on other families income, so no family member is able to break the pattern of poverty
chemical abuse
drug dealing to support a habit
mental illness
parents, spouses, brothers, sisters in prison
criminal activity as income
crime as a family enterprise
Persons who are members of the underclass see dysfunction as normal. They've never known any different. Many think this is how everyone lives. While they may dream of a good job, they appear to not have the self-discipline to keep a good job. Many of this group might be diagnosed with an anti-social personality DO. Personally, I think this diagnosis is misleading at best. A person earns this diagnosis if their history includes sufficient "anti-social" behavior. This doesn't account for family cultures that teach a confusing mix of conventional and anti-social values. Thus we have neighborhoods that have no constructive relationships with police, believe that justice is against them and label anyone reporting a crime as an informant and not to be trusted. This of course contributes to the chaos in the neighborhood.
In my experience people who get diagnosed anti-social are the ones the clinician don't trust or believe. The whole underclass culture tries to keep their business to themselves. Lying to protect one's family's reputation is encouraged. I suspect while there may be a few classic psychopaths out there, most of those folks who populate our jails are drug abusing, impulsive, underclass members with shut down emotional systems due to repeated chaos and trauma. These folks won't tell you the truth unless they are desperate and already feel they are the lowest of the low. Their judgment is so impaired that they see fear as a weakness they must squelch out. Danger in their world is everywhere and it must be faced, not avoided.
I have worked with some persons of the underclass who have a clinical presentation of PTSD after many years of participation in gang violence. They know what conventional values are, but they also know what is the law of streets. They are scared and tired of living a nightmare, and want a stable peaceful life but are tortured about what they've seen and what they've done to others over the years. Just seeing a gun sets off flashbacks. They describe their younger years as being "shut off" emotionally, and "not caring" about anyone or anything but money. But now in my office, they are presenting a mostly full range of emotion and a guilty conscience that suggests conventional values. Has their impulsive, "immature brain", associated with anti-social acts, matured into a more conventional pattern? Or is it more accurate to describe them as a product of an anti-social sub-culture? I suspect the latter is more accurate.
Returning to the homeless and Kellevision, she notes the major problem with relationships is homeless people's "picker is broken".
"For every person in a homeless shelter with dependency issues we seem to have an predator waiting for them. Half the population seems to be working or receiving some form of assistance and the other half seem to be trying to hook up with them to take advantage of that income....
It is important to realize that single parents contribute to the problem of picking the wrong partner with their own pathology. The single mothers in the family dorm are not simply victims of the men they pick out. There seems to be a predominant attitude of these women that the man should "take care of them". They believe it is just a matter of picking out the right one. The first problem is that their "picker" is broken. They do not pick out a good one. They usually pick out one of the predators roaming the alley behind the shelter. The second problem is that you cannot sit at home expecting to be taken care of in our modern economy. That might have worked in the 1950's, even in the 1970's, but June Cleaver is no more. The modern American household takes two paychecks. Two full-time paychecks. The third problem presents it self when the man expects to be supported by the woman. Even if the woman is working full-time and picks out a man who wants to live off of her, women traditionally earn much lower wages than men. So the family's financial stability is even more shaky.
This predatory - dependent dyad seems to play out in most of their relationships and I wonder if it is not the source of their alienation from their families of origin. A person who constantly expects to be taken care of can be quite tiring. By contrast, a person who is constantly preying on others also becomes quite tiring. "
Having grown up in a chaotic home and living a chaotic lifestyle, repeated trauma has numbed their emotions to the point that they are unable to make proper judgments about who is worthy of trust. The predator-prey dyad began in their family of origin where parents exploited the children when they were young, and when the children grow up, they exploit their vulnerable elderly parents. Recently, in my therapy group, one male member admonished a older woman for setting limits with her adult children because they were tacitly supporting her grandchildren for default on a loan she'd co-signed. He felt family was entitled to lean on, effectively use, each other.
"Mental illness is often cited as a factor in homelessness. A significant number of homeless clients suffer from debilitating mental illnesses and many researchers sight the high numbers of mental illness in the population. However, each researcher seems to define it in their own way. Some include only the big three Axis I diagnoses (Schizophrenia, Bipolar I and Major Depression). Others include substance abuse (since it is an Axis I diagnosis in the DSM IV) which dramatically inflates the numbers of the "mentally ill". Others include Axis II personality disorders, but only some of them, usually Antisocial Personality Disorder. Still others include Post Traumatic Stress Disorder. In my experience, mental illness is a factor in about 10-20% of our homelessness clients and it is a serious problem. However, it does not explain the other 80%. These 80% use an unusually high percentage of services and monies devoted to the homeless and they are repeat customers. "
Here I have to disagree with Kellevision. Everyone I've counseled with substance abuse were running from their feelings about themselves and/or their past. I have found Bipolar DO in significant numbers behind petty criminal activity, gambling addiction, alcoholism, sexual addiction, exotic dancing and prostitution. I participated in a local county survey that identified their most expensive clients. The general profile was bipolar chemically abusive who revolved in and out of the hospital, placements and jail. Personality disorders are mental illness. While many may think the rest of the world is the problem and are not willing to take responsibility, many others are desperate for relief from a horribly chaotic and often traumatic life.
"There is a very high incidence of traumatic histories in the homeless community, even before they became homeless, usually during childhood. I believe that a majority of the substance abuse problem in this population is an effort to treat trauma symptoms. However, this can be said of other populations as well, including the substance abuse community. Most trauma survivors manage to maintain housing despite their trauma symptoms. Though trauma symptoms may play a factor in homelessness, I do not believe they are the sole cause. "
Sole cause, no, it's the multi-generational underclass sub-culture with it's accompanied fractured families, drug abuse, trauma, predator/prey cycle, and chaotic lifestyles. Trauma comes in forms that are not readily identified. Chaotic events in close proximity in time give the victim the impression they have no control of their fate and so they scramble for every edge in the moment, and anxiously await for the next disaster to strike. Those in the underclass go way out of their way to withhold their histories of trauma and chaos, insisting that they can handle their own problems, and it's none of anyone's business. Or is this simply the accepted cultural method to deal with the shame of their past?
"Most homeless clients do not have family support systems. If they did, the family would take them in and they would not be homeless. Many homeless clients come from families who are themselves very nomadic and teetering on homelessness. Some come from families rife with substance abuse, sexual abuse or domestic violence. Others have been rejected by their families for various reasons. These reasons often involve their dependent and/or dysfunctional behaviors. "
Underclass families exploit each other until the resources are gone, or the member with resources cut off the leech. Once the underclass has used up their family resources, they become at risk for homelessness. Many have family who died young living violent or drug infested lifestyles, or who are in prison. By this time, they've burned out most of their friends as well. All they can do and meet new vulnerable people and continue a new predictor/prey dynamic.
So what solutions are there for healing the cultural divide? The problem is mostly economic. The underclass lacks a realistic chance for escaping their plight. Oh, sure a few make it, usually through advanced education. But many will hit a ceiling in achievement when they rely too heavily on "temporary feel good" behavior that provides relief from stress, but self-destructively complicates their lives and increases the chances they will fall out of their newly found middle-class status.
The middle-class in America is shrinking, many of the hard working blue collar workers are falling into the underclass from where with a floundering economy, escape will be difficult. Jobs programs, affordable housing, and counseling are sorely needed but remains largely unfunded. What infrastructure is present is actually shrinking with government tax dollars.
Too often the only role models for success are the gang members, drug dealers or pimps who drive fancy cars and flash wads of money. Too many get lost in this dream turn nightmare. But my experiences working with recovering gang members is that many are retrievable when they get desperate enough to escape with the right kind of treatment and patience with their guarded presentations. I work in a Partial Hospital Program (PHP) at an inner city public hospital that is designed to intervene with persons with personality disorders. It's largely based on the Crisis Intervention model that relies on the desperation of the client to inspire commitment, insight and behavior change in therapy. The PHP format is ideal for persons who are suffering from acute exacerbation of substance abuse, PTSD or personality disorder. I call it "mental health boot camp". We have a satisfaction rate of over 90%.
Kellevision lists a number of problems within the system.
"In my humble opinion, our current social services system and is a major factor contributing to the homeless mindset. This is a complicated element to explain. But I think it is important to make an attempt.
I see two major problems with the social services system: 1) the system itself - how benefits are applied and eligibility determined and 2) the people working within the system - the mindset of caseworkers and social workers working with the homeless population. "
The social services system seems to be designed to punish attempts by the poor to achieve independence. Assistance programs penalize people for working "too much" by cutting off benefits when assets accrue. These systems often reinforce irresponsibility and impulsivity while punishing people who try to work and plan ahead.
Many social services programs seem to "teach" clients to wait until the last minute then create a dramatic "emergency" in order to get help. This fosters the emotionally immature and histrionic displays in emergency rooms.
Our current welfare system does not allow exchanging work for benefits. Benefits are given away free.
Caseworkers and social workers have a bad habit of doing things for clients, rather than expecting the client to do it or teaching them how.
So what have clients learned so far?
Don't work too much.
Don't plan ahead.
Expect someone else to provide you with what you need.
Don't take responsibility. Someone else will fix it for you.
The welfare system is complex, cumbersome, and difficult to change into a working entity. The major problem is that it is designed not to serve the poor, but to mollify the political needs of the tax payer. That makes it inherently punitive. As we know from behavioral science, punishment doesn't change behavior. I believe it in fact feeds the cycle similar to the one Kellevision describes above. As long as we put political considerations ahead of evidence-based methods, we'll have a broken system.
Kellevision proposes ideas that I think have significant merit.
"I think counseling should be provided liberally. Teach people how to fish. Teach them how their maladaptive behaviors impair their ability to function. Stop rewarding bad behavior. Stop giving away money. Stop cleaning up their messes for them. Stop giving away free stuff.
Once homeless clients are assigned jobs, they would be provided with counseling to address the behavior problems that interfered with their ability to maintain employment. If they failed to come to work due to a poor work ethic, substance abuse problems, domestic violence or other relationship issues, etc. instead of getting fired - again - and having another black mark on their work history, they would be required to participate in counseling or group work to address it. "
We spend billions on imprisoning the largest proportion of our population than any other nation. Too many of those imprisoned are petty drug offenders. In prison, they some learn how to be more effective criminals and then are turned loose to re-offend. Too many are very young.
Petty drug offenders often need CD treatment, not prison. Many are simply supporting the habit that keeps them from a more productive life. However, petty criminals can become hardened career criminals just from the experience of prison.
These are facts that have been known for many years. The only thing that keeps us from acting on this knowledge is an uneducated electorate. At the recent APA convention, another expert repeats the message.
"The current design of prison systems don't work," said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona. "Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence."
Presenting at the American Psychological Association's 117th Annual Convention, Dvoskin discussed his upcoming book, "Applying Social Science to Reduce Violent Offending," which examines why prisons are failing and what needs to change.
"Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want," Dvoskin said in an interview.
Applying behavior modification and social learning principles can work in corrections, he said. "For example, systematic reinforcement of pro-social behaviors is a powerful and effective way to change behavior, but it has never been used as a cornerstone of corrections," he said.
Also, punishment can be effective in changing behavior, but it only works in the short term and immediately after the unwanted behavior happens, he said. While there is a place for punishment, it should be used in psychologically informed and effective ways. However, punishment should not be one-size-fits-all, Dvoskin said.
"We need to know what may be behind the criminal behavior to know what the best treatment is," he said. "A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior.""
Valium is widely known as an addictive drug that is still occasionally prescribed for anxiety. Long-term use of Valium takes risks with a drug with perhaps the worst withdrawal syndrome of any addictive drug. Now there is evidence that the addictive effects occur with the very first dose of the drug.
"... a single drug or alcohol dose is sufficient to generate an initial stage of addiction. Recent research conducted under the umbrella of the Academy of Finland Research Programme on Neuroscience (NEURO) has discovered the same phenomenon in the dosage of benzodiazepinediazepam.
"Previously, addiction to benzodiazepines has been explained by reference to negative rather than positive reinforcement. In other words, the thinking has been that the reason people continue to use the medicine is that it helps to alleviate their distressing withdrawal symptoms and general discomfort, rather than because it provides a sense of reward," says Professor Esa Korpi, who has been in charge of the research project at the University of Helsinki.
However, according to the latest research it seems that diazepam causes a similar change in the brain's reward-inducing dopamine cells as a dose of alcohol, morphine, amphetamine or cocaine.
Furthermore, neural message transmission in the dopamine cells is reinforced for up to 72 hours after ingestion of diazepam.
"Our studies have shown that diazepam also affects the dopamine system, which adds a new positive reinforcement mechanism of reward learning to the theory of benzodiazepine addiction," Korpi explains."
There has been a long standing myth about marijuana that has been around since the 1960s. The myth says marijuana is less harmful to you than alcohol and tobacco. At best the myth is misleading. At worse, it becomes part of the denial based self-justification for marijuana dependence.
Marijuana today is 100 to 1000 times the strength of marijuana of the 1960s. Studies from that era are simply no longer applicable. At that time, it was asserted that marijuana is NOT addictive, rather it produces psychological dependence on those so inclined. This is still a controversial topic today. Addiction theory hinges on a habituation response. Alcoholics "learn to handle" more alcohol before getting drunk. Actually, their body becomes tolerant to it's psychological effects. Other addictive drugs are well known for their habituation response.
Marijuana is said to not habituate. However, there is one problem with this assertion. Marijuana is a highly variable substance. It has a number of differing amounts of psychoactive alkaloids. So effectively, each plant is a different mix of a variety of "drugs", not a consistent dose like an ounce of alcohol. So it is possible, I believe probable, that while habituation builds as the original source is consumed, tolerance starts at least partly from the beginning with a new plant.
Marijuana's worst behavioral effect for frequent users (weekly), is what has been called "amotivational syndrome". Regular marijuana users lose the will to work hard to better their lives. They become content to sit still, appear "lazy", lose creative energy and the willingness to take risks in novel ways. Personal growth grinds to a halt.
Marijuana has a withdrawal syndrome similar to tobacco, as we see below. We all know how addictive and destructive tobacco is to our health. Add to that amotivational syndrome from marijuana and you have a drug that rivals alcohol in it's destructiveness to people's lives. And we are just beginning to understand how marijuana affects our bodies and minds, especially young developing minds.
[...]Very broadly consistent with symptoms established for other drugs of abuse, including nicotine.
[...]Discontinuation of both substances seemed to cause the greatest degree of withdrawal, particularly in terms of anger, irritability and aggression. Cannabis discontinuation (alone) seemed to cause sleep disturbances for longer than did nicotine discontinuation (alone). Perhaps most strikingly, the discontinuation of cannabis (alone) or nicotine (alone) seemed to produce approximately equivalently severe withdrawal symptoms as rated by these dual-users.
[...]In total, these studies paint a picture in which the discontinuation of nicotine and cannabis produce withdrawal symptoms of relatively similar severity and in similar proportion."
While still excluded from the DSM IV TR, Internet addiction has graduated to a subject worthy of research. And not surprisingly, like all other addictive behaviors, what I like to call "temporary feel goods", are associated with a lot of other diagnoses. Avoiding negative emotions has serious consequences, beyond even addictions.
"Internet addiction were more likely to have MDD, dysthymic disorder, social phobia and adult ADHD than their unaffected counterparts. Adult ADHD is the most significant predictor for Internet addiction, followed by depressive disorders. Social phobia, however, was not correlated with Internet addiction in our sample after controlling for depressive disorders and adult ADHD. Further, depressive disorders and Internet addiction were associated in the male college students, but not the females."
It would appear that one of the most abused drug among teenagers maybe available at home in the medicine chest. Prescription drugs were reported abused by a disturbingly high proportion of high school students. If I recall my numbers correctly, the usual proportion for life time alcohol abuse at about 60%, marijuana abuse in the 25% range, cocaine and sniffing glue around 10%. Nearly 1/2 high schoolers have abused prescription drugs and about half of them had given or sold the drugs to others. Ten percent to PARENTS!
Remember the classic and coarse stand up comedy of George Carlin, and his 1970s diatribe on "DRUGS Store"? He observed that the young people's preoccupation with getting high in the 60s and 70s were driven by the culture of pill popping parents who bought their drugs off the glitzy TV ads from pharmaceutical companies. I think his point is well demonstrated in the data in this survey.
"Rates of prescription use and misuse were high in this single-site survey. Several surveys have highlighted increases in the nonprescribed use of prescription drugs among adolescents. In the current study, researchers constructed a web-based survey with questions about four classes of drugs (stimulants, sedatives/anxiolytics, pain medications, and sleep aids). The participants were 1086 students from 7th through 12th grades from a single school district (age range, 11–17; 68% of eligible students). There were similar numbers of each sex and race (white and black).
Thirty-six percent of respondents had at least one prescription from at least one drug class within the past year, and 49% had at least one during their lifetime. The most common class was opioid analgesia (past year, 33%; lifetime, 45%). Of the respondents, 24% gave away or loaned their medications; 10% acknowledged diverting drugs to parents, 8% to siblings, and 19% to friends. Teens were significantly more likely to divert drugs to same-sex friends than to opposite-sex friends. Of 390 students with past-year prescriptions, between 29% and 62% were asked to divert their medications.
Comment: The burgeoning problem of prescription medication diversion has been associated with high rates of illicit-substance use. The sobering data require both further research and development of preventive and interventional strategies, e.g., school-based health education. Whether nonprescribed diversion is related to the specialty of the prescribing physician and whether physicians discuss diversion with patients would be useful to know. An immediately useful approach for psychiatrists would be to inquire about all medications that other physicians have prescribed for their patients.
— Barbara Geller, MD
Published in Journal Watch Psychiatry April 30, 2007
Citation
Boyd CJ et al. Prescription drug abuse and diversion among adolescents in a southeast Michigan school district. Arch Pediatr Adolesc Med 2007 Mar; 161:276-81. [Medline® abstract]"
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