Question: I have been a daily heroin user for more than 7 years. i have gone through detox a couple of times but I have never stayed clean for more than a couple of weeks at any one time. One thing that always gets me is how crappy I feel when I don't use, even after I am over the worst of the withdrawals. I understand that my dopamine systems can be damaged for a long time after a long time of heroin use and that this can make it hard for me to feel pleasure like I used to feel before I started using heroin What I want to know is how much of my dopamine systems I can expect to recover and how long this is going to take. If I know that things will get better then maybe i will be able to stick it out when I try next time.

Dr. James Strawbridge Says...:

There is only one addiction---dopamine addiction. When heroin addicts shoot up, the street drug causes their brains to produce dopamine. Heroin is a trigger. It's the dopamine flow that actually creates the sensation of being 'high.' When it comes to scoring dopamine rewards, there are many triggers. For some the target is cocaine. For others it can be nicotine, alcohol, sex, gambling, or food. Psychological dopamine addictions are more insidious because the dopamine is triggered by highly addictive emotions, memories, thoughts, fantasies, ideologies, rhetoric, and deceptions. Researchers have recently added video games and texting to the list while continuing to ignore the most dangerous triggers that have come to be considered “normal” behaviors. 

The treatment of opioid addiction can be grouped into opioid maintenance with methadone versus abstinence approaches. Choice of proper treatment depends on ones characteristic. The course of heroin addiction typically involves a 2 to 6-year intervals between the start of regular heroin use and seeking of treatment. Treatment takes total psychosocial rehabilitation.

Methadone programs substitute a long-acting methadone for short-acting heroin, and then gradually withdrawal from the methadone. They transfer the addiction from heroin to methadone. Methadone is administered to the patient orally at established methadone clinics. Although a mainstay of treatment, these programs reach only 29% to 25% of addicts, with program retention rates between 59% and 85% (Stimmel, Goldberg& Rotkopf, 1977). Opioid detoxification should be slow to avoid relapse. The drug should be removed by as little as 10% per week. Total abstinence may be the only alternative for many patients. Best of luck. 

Question: I am a long time heavy drinker. What are signs that I need to be on the look out for that would point out that I am starting to damage my liver?

Dr. James Strawbridge Says...:

Alcohol is a drug,
and if you are addicted to alcohol, you are an alcoholic. Alcohol is a
compound---CH2  CH5 OH---an  ether
like substance, a sedative hypnotic drug.

Addictionologist
G. Douglas Talbott, M.D. states that your brain has no more idea than a
pussycat does whether you O. D.’d on alcohol, meprobamate, miltown,Equanil,
Phenobarbital, Valium, Librium, or any one of dozens of other sedative hypnotic
drugs. The brain gets the same message from sleeping pills and tranquilizers as
it does from the beverage alcohol. But many aren't ready to look at that yet.

If you take a
bottle of beer or wine or any kind of alcoholic beverage---scotch, bourbon,
after-dinner liqueurs, gin, vodka---whatever alcohol beverage you want---take
away the color and the taste, stick in a spigot, and drip off the water, you
have ether. The body and the brain have no idea whether you’re in an operating
room, breathing ether from a mask on your face, or in a field drinking beer.
The chemical message to the body and brain is the same.

Alcohol can damage the liver, leading to inflammation (alcohol hepatitis) and swelling of the liver. Over time, this inflammation and damage progress to form scar tissue, resulting in cirrhosis of the liver. Cirrhosis of the liver is the end stage of alcoholic liver disease. Symptoms of alcohol liver disease include abdominal pain, tenderness, jaundice (yellowing of the skin and whites of the eyes), fatigue, and nausea. After cirrhosis has developed, fluid buildup in the legs and fluid collection in the abdomen are common. Bleeding problems may also occur. Malnutrition is a common complication.

Alcohol liver disease is a serious condition that continues to get worse if alcohol consumption is not discontinued, along with other essential treatment. Late-stage symptoms can also include confusion and mental status changes, excitability, impaired memory, and difficulty with movement. 

I would suggest that you seek medical care for serious symptoms, such as constant weakness, dizziness, problems with thinking and memory, hallucinations, mood changes such as agitation, extreme fatigue, fainting, fever (especially if combined with a swollen abdomen), vomiting (possibly with blood),   

Question: Can you recommend a good self help book for someone who wants to work on what is I guess called alcohol abuse but not alcoholism? I want to try to fix things on my own if I can but so far I am not doing very well at reducing my intake.

Dr. James Strawbridge Says...:

There are many books to read on this subject. My offering is to determine whether you are an abuser of alcohol or have you become dependent:

Alcohol Abuse Screening Questions

A yes answer to one or more of the
following during the past 12 months indicates alcohol abuse.

1. Have you, more than once, driven a vehicle while you were
   drinking, or after having had too much to drink? ____
2. Have you gotten into situation while drinking, or after
   drinking, that increased your chances of getting hurt – like
   swimming, using machinery, walking in a dangerous area, or near heavy
   traffic?_____
3. Have you continued to drink even though you knew it was causing
   you trouble with your family or friends? ____
4. Have you gotten into physical fights while drinking, or right
   after drinking? _____
5. Have you gotten arrested, been held at a police station, or had
   any other legal problems because of  your drinking?____

When alcohol abuse progresses to alcohol
dependence, the drinker loses control of the amount they drink and
cannot stop using alcohol despite the severe physical and
psychological consequences of excessive drinking. 

*Alcohol Dependence Screening Questions

A yes answer to three or more of the
following during the past 12 months indicated dependence.

1. Have you had times when you ended up drinking more than you
   meant to, or kept on drinking for longer than you intended?_____
2. Have you, more than once, wanted to, or tried to stop or cut
   down on your drinking but found you could not?____
3. Have you found that you have to drink much more than you once
   did to get the effect you want, or that your usual number of drinks
   has much less effect on you than it once did?____
4. When the effects of alcohol are wearing off, have you had
   trouble sleeping, or experienced physical symptoms such as shaking,
   feeling nervous, nauseous, restless, sweating or rapid heartbeat?
   Have you sensed things that aren't really there, felt bugs crawling
   on your skin, or had seizures? ____
5. Have you taken a drink or used any drug or medicine
   (over-the-counter pain relievers) to avoid having bad after-effects
   of drinking, or to get over an after-effect of alcohol use, or
   hangover? ____
6. Have you continued to drink even though you knew it was making
   you feel depressed or anxious, causing a health problem or making one
   worse, or has caused a blackout? ____
7. Have you had a period when you spent a lot of time drinking,
   being sick, or getting over the negative after-effects of drinking?
   ____
8. In order to drink, have you given up, or cut down on activities
   that were important to you, interesting or pleasurable? ____

*Many of the signs and symptoms of alcohol abuse overlap
with the signs and symptoms of alcohol dependency. There is a
fine line between the two, but the crossover occurs when the person
becomes dependent on alcohol. An alcoholic is unable to control their
drinking, they have built up a tolerance to alcohol which over time
requires them to drink larger quantities of alcohol in order to
obtain the same effect, and they will usually experience withdrawal
symptoms when they don’t drink.

*Adapted from the Diagnostic and
Statistical manual of Mental Disorders-IVTR and the National
Institute on Alcohol Abuse and Alcoholism.

Question: Does alcoholism increase a persons risk for Parkinson’s disease? When my brother gets very drunk which is something that happens every day he starts to move back and forth like he doesn't have control over the muscles in his head and neck. It looks just like what my grandfather used to look like and he had Parkinson’s. my brother is only 38 year old but his body is not in good shape from a lot of years of very heavy drinking.

Dr. James Strawbridge Says...:

Alcoholism can cause parkinsonian like symptoms but it is not considered to be a cause of Parkinson's disease. However, alcoholism can cause tremors similar to Parkinson's disease. For alcoholics, the development of a tremor is due to damage to the part of the brain that coordinates movement. This can lead to poorly controlled movement and a chronic tremor. According to the NIH, "Alcoholism, excessive alcohol consumption, or alcohol withdrawal can kill certain nerve cells, resulting in tremor, especially in the hands." Keep in mind that one test for essential tremor is to see if it is alcohol responsive - meaning that the tremor may stop with alcohol intake.

http://www.ninds.nih.gov/disorders/tremo…

Question: My ex-husband and father of my child is a chronic alcoholic and was already showing signs of brain damage from the disease in 1997. He is a chronic alcoholic and basically drinks every waking moment. He had a bad fall recently and had to undergo emergency brain surgery. He is in a coma (not drug induced) and on a ventilator. I need some more info on the chances of him recovering from this. I am certain that by now he has severe wet brain syndrome and he has also had a couple of operations on his pancreas. I need to be able to tell my son what the probable outcome of this latest catastrophe is going to be. Please could you help. I am a member of Al-Anon and have a great understanding of this terrible disease.

Dr. James Strawbridge Says...:

Heavy alcohol consumption for extended
periods of time has extensive and far-reaching effects on every organ
of the body. The effects on the brain can range from 'slips' in
memory to permanent and debilitating conditions.

Research has shown a high deficiency of
thiamine in the diet and heavy alcohol consumption for an extended
period of time to be a bad combination. In worse cases people will go
on to develop serious brain disorders such as Wernicke-Korsakoff
Syndrome.

According the the National Institute on
alcohol and alcoholism, “WKS is a disease that consists of two
separate syndromes, a short-lived and severe condition called
Wernicke's encephalopathy and a long-lasting condition as Korsakoff's
psychosis.

Patients with Korsakoff's psychosis are
forgetful and quickly frustrated and have difficulty with walking and
coordination. Although these patients have problems remembering old
information, it is their difficulty in “laying down” new
information that is most stricking. For example, these patients can
discuss in detail an event in their lives, but an hour later might
not remember ever having the conversation. Cases of this type may
require a lifetime custodial care, enduring love and patience.

Question: Is it true that you should not take tylenol or advil after a big night of drinking because it is hard on your liver?

Dr. James Strawbridge Says...:

I
would
be cautious about the mix. The risks seems to be
largely confined to people who drink relatively
high levels of alcohol and take higher-than-recommended of amounts of Tylenol (acetaminophen) or
Advil (ibuprofen).

Acetaminophen
has been named in several studies that
the cause of sudden liver failure in rare instances. In most of those
cases, overdoses of acetaminophen were taken; that is, above the
recommended four grams or eight tablets for a day. In many cases,
relatively heavy drinking -- six drinks a day or more over a long
period of time -- was also found. In some cases, though, the sufferer
denied taking more than the recommended dose and reported taking no
more than three drinks.

It
is not clear how much the overdose and how much the drinking
contributed, but McNeil Consumer Products lost a lawsuit in which one
patient said the combination of moderate drinking and taking Tylenol
caused his sudden liver failure and the need for a liver transplant.
McNeil, a division of Johnson & Johnson, subsequently put
a warning written by the Food and Drug Administration in its Tylenol
packages to alert consumers.

Question: Sometimes when I get very drunk I wet the bed in the night (with urine). This only happens once or twice a year. It happened last night and I had my new girlfriend sleeping over. This was very embarrassing. Should I be worried that I do this? I have never really talked to anyone about this before because it is fairly embarrassing to admit. Is this a common thing or do I need to get checked out medically?

Dr. James Strawbridge Says...:

Bedwetting problems often arise for those who go out and have a big night drinking alcohol, sometimes they experience urinating during their sleep that doesn’t arise when they don't consume as much alcohol as they normally would. This type of bedwetting is still a form of nocturnal enuresis, but it differs from normal bedwetting problems in that it is specifically caused by excess alcohol consumption.

Alcohol is the main trigger factor in these types of cases because alcohol is a diuretic, excess consumption causes the body to try to expel it as quickly as it can, meaning you need to urinate more often. Going to sleep doesn’t always eleviate this, and the body will still reject excess liquids that it has trouble processing - leading to bedwetting during the night, often more than once. Lets look at why the body rejects the alcoholic liquids, and why this turns into bedwetting problems. The kidneys and liver process alcohol of alcohol of alcohol are consumed and the bloodstream converts the excess fluids into urine. This process is hurried along with excess amounts, because your body works hard to return to normality and purge the extra alcohol. At night, if you have consumed a lot, even in your bed your body is still attempting this process.

When you combine this with the fact that being ‘drunk’ often makes you tired and of poor judgement, your body's normal signals to you, to get up and go to the toilet (to avoid bedwetting) might be ignored in place of that comfortable, long sleep you desire.

So its important that if you do find yourself wetting the bed during a night after having heavy amounts of alcohol, be aware of this before you start drinking. The only way to end this problem is to limit your alcohol consumption and ensure your body can handle what you put into it. Aside from not bed wetting, and a dry nights sleep, there are numerous other health benefits to giving up excess alcohol consumption. If you find you drink enough to regularly wet the bed at night, this may always occur. Also, consider your partner. If they are having to share a wet bed with you, while you are heavily asleep, that is impacting their life also. There is much more than just bedwetting to be cured, when you make the decision to give up excessive alcohol drinking.

Question: We moved for my work a year ago. Since that time my wife’s drinking has gotten increasingly out of control. She drinks a bottle of wine at least every day. We are scheduled to move back home in 6 months. She says she is only drinking so much now because she is so bored and once she goes back to her life at home she will cut back to a healthier amount. I am kind of worried that she is becoming an alcoholic. Is it very risky for me to wait 6 months to see if what she is saying is true? Should I force the issue now or wait and see? She is not causing any problems to our relationship but I just do not think it is healthy.

Dr. James Strawbridge Says...:

With the information you mention, the following are my thoughts.

The consumption of alcohol can have positive as well as negative effects. There is some evidence associating light drinking with improved emotional, mental and physical health. But there is an emerging picture of alcohol use as a way of masking problems, and helping us cope with emotions we would otherwise find it too difficult to deal with.

Alcohol is tied up with many areas of our lives, and we use it in a plethora of ways: to help us relax, feel brave, introduce ourselves, seal business deals, celebrate life events, drown our sorrows, remember, forget, welcome people, say goodbye to people, get to know people, manipulate people, because we feel like it, because we need it, to numb ourselves, to feel grown up, to feel young, to belong, to distinguish ourselves, and sometimes, because we’ve forgotten how to do anything without alcohol.

There are two potential problems in using this as a coping mechanism. Firstly, self-medicating with alcohol can become self-perpetuating. Underlying anxiety leads to increased alcohol use, which changes the physiology of the brain and leads to a depletion of the neurotransmitters (the brain’s ‘messengers’) that it needs to reduce anxiety naturally. Therefore, the individual feels more anxious and needs more alcohol to ‘numb’ their anxiety. In the long term, this can lead to an individual becoming tolerant of alcohol – that is, they need increasingly large amounts of drink to experience the same reduction in their anxiety.

I would posit that drinking a bottle of wine each day can lead to a tolerance that will require more alcohol to get the same results...and this can lead to alcohol dependence. An assessment will objectively answer many question you may have in an effort to help.

Question: I am 2 months sober. I am doing it on my own and it is working Ok for me. The problem I have is that it does not seem to be getting any easier. Every night I am on the edge of going and buying a bottle and every night I have to fight it. How long does it take before I won’t have to fight so hard not to drink every night? I am willing to keep fighting but I would like to know that it is going to get easier at some point.

Dr. James Strawbridge Says...:

First of all, alcoholism is a serious and potentially fatal illness. The first step in the recovery process and by far the most comprehensive is that you admit you have a problem and develop the desire for sobriety as much as the desire for the next drink.

The most serious alcoholics are those who have become physically and psychologically dependent on alcohol, usually with grave damage in more than one of the life areas: physical health, emotional well being, interpersonal relation, and social and vocational functioning. Often the damage extends to all of these areas. In lay terms, they suffer advanced alcoholism. For those, the achievement and maintenance of sobriety is first and always the primary treatment goal: abstinence from alcohol is the alpha and omega of treatment with the gamma alcoholic. A certain number of gamma alcoholics will be able to achieve stable sobriety, either by their on efforts or, more usually, through some combination of professional treatment and AA participation. Those who reach stable sobriety are referred to as recovering alcoholics, said another way: their alcoholism is in remission.

Some recovering alcoholics reach a stable, more or less satisfying adjustment without formal help, many others find that the AA program and other self-help groups meet their emotional needs. However, many recovering alcoholics do turn to psychotherapists for additional help, Often they find AA's fellowship extremely important because they find they can not recover by themselves. The rooms of AA are full of those who tried to gain sobriety by themselves without success.

The emotional pain of attaining sobriety alone can be discouraging. It is not advisable. Working with an empathetic psychotherapist and involvement in AA supports is advised.

Question: Should I be weirded out by the scientology links at narconon? I am not a religious person but I’d go to a Christian rehab if I thought it would help me get quit drinking and pot. To me the sound of not using more medications and sweating out the toxins in my body makes a lot of sense. I don’t care if people around me are into weird religions as long as they don’t pressure me on it too much. Do you know much about the narconon treatment programs? They have a very high success rate.

Dr. James Strawbridge Says...:

I do not have the understanding or experience of being exposed to either scientology or narconon. 

According to Wikipedia, the free encylopedia found on the internet “the hypothesis underlying the program is that drugs and their metabolites are stored in the body's fatty tissues, causing the addicts cravings when partially released later, and can be flushed out through a regimen comprising elements such as exercise, sauna and intake of high doses of vitamins.” I would recommend you read the entire article plus do your own research. 

Here say is a flimsy foundation for commitment to a program sharply criticized by the medical profession. Why rely on theories of drug metabolism that are not widely supported?   

There are many Christian rehabs across the country. Again research on your part is necessary. There is no easy way to stop drinking alcohol or smoking pot. It takes time to get cuffed to any addiction. Discipline, structure,and the right kind of activity will lead to freedom just as the wrong discipline, the wrong kind of structure and the wrong kind of activity will lead you to the bondage of addiction.