The difference between alcohol abuse and alcohol addiction (alcoholism), what puts you at risk of becoming an alcoholic and what to do once you’ve crossed that invisible line to addiction.

“People who drink to drown their sorrow should be told that sorrow knows how to swim.”

- Ann Landers¹

If you or someone you love struggles with alcohol, you need to get informed - so read on and learn about: the differences between alcohol abuse and alcohol addiction, behaviors that increase or decrease your risk of addiction and what to do once you're addicted, and ready to stop!

Alcohol Abuse vs. Alcohol Addiction and Alcoholism

So do I have an alcohol abuse problem or is it alcohol addiction or alcohol dependence…and what about alcoholism? Is that worst of all?

It’s not easy to get an accurate diagnosis and sometimes, with all the different terminology in use – you can get an accurate diagnosis and still feel confused!

So to put it most simply, there are 2 basic kinds of alcohol use disorders:

1. Alcohol abuse (problem drinking)

2. Alcohol dependence (alcoholism and alcohol addiction mean the same thing as alcohol dependence)

Alcohol Abuse

Alcohol abuse is also sometimes known as problem drinking, and this term actually describes the situation pretty well – when your drinking starts causing you problems…you have a drinking problem (an alcohol abuse problem).

Some common signs of an alcohol abuse problem include:

• Getting into legal troubles from your drinking (fights, alcohol fueled domestic disputes or DUIs for example)
• Your drinking or hangovers repeatedly interfere with your ability to meet your responsibilities (at work, as a parent, at school etc.)
• You drink in risky situations, such as when driving or using heavy machinery, when on medication that may enhance alcohol’s effects or against your doctor’s advice
• Continuing with drinking patterns that cause you relationship problems, such as repeatedly fighting with your spouse about the way you act when drinking or about getting drunk with friends
• Needing alcohol for stress relief

Alcoholism (Alcohol Addiction, Alcohol Dependence)

In addition to experiencing the problems of alcohol abuse, alcoholics will also:

• Develop a tolerance (need more to get the same effects)
• Start feeling withdrawal symptoms. After the alcohol in your body wears off you feel some or all of the following withdrawal symptoms: shakiness/trembling, anxiety and jumpiness, insomnia, irritability/depression, nausea and vomiting, sweating, headaches and loss of appetite
• Lose control over use – drinking more or for longer than you had wanted to
• Become unable to stop – You want to stop or cut down your use but you can’t seem to accomplish this
• Keep drinking despite negative consequences – You keep drinking even though you know that alcohol is seriously harming your health/relationships/work or school performance/parenting or some other important facet of life
• Become preoccupied with alcohol – You spend a lot of time, drinking, getting alcohol and recovering from drinking and you don’t engage in many activities that aren’t related to drinking
• Drop non alcohol-related activities and relationships that used to be important²

Not all alcohol abusers become alcoholics, but abusing alcohol puts you at high risk to develop alcoholism.

What Puts You At Risk of Alcohol Addiction?

Having a family history of alcoholism increases your risk of developing the disease. Children of alcoholics are about 4 times more likely than the general population to develop an alcohol problem.³

But that being said, you still control your fate and if you choose to abstain from alcohol, you are at no risk of becoming an alcoholic, no matter how many close family members might be alcohol dependent.

Although genetics play a role, many close family members of alcoholics never develop a problem and many people without an alcoholic family member become alcoholics…so clearly environmental factors play a significant role in determining your risk for this disease.

Besides your family history (which you can’t control) other environmental and genetic factors which increase your risk of alcoholism include:

• Regular heavy drinking – Defined as more than 15 drinks per week for men, 12 drinks per week for women and more than 5 drinks in a sitting
• Starting young – People who start drinking at a young age (young teenage years) are at a much higher risk to become alcoholics at some point in life than people who wait until the age of 21 to start drinking. In one study, people who started before the age of 15 were 5 times more likely to become alcohol abusers or alcoholics than people who waited until the age of 21 to start drinking⁵
• Having a psychiatric disorder – People with depression, anxiety, ADHD and other disorders are at much higher risk of alcoholism and addiction than people from the general population.
• A history of abuse – People who were physically or sexually abused as children are more likely to develop alcohol problems⁶
• Cultural and social factors – If you live in a heavy drinking community you may be more likely to drink to excess yourself. Having a heavy drinking spouse or close friends may also increase your risk.

Minimizing Your Risk of Alcohol Addiction

The best thing you can do to minimize your risk of alcoholism is to drink in real moderation – or don’t drink at all (although it sometimes feels like everyone drinks, in fact almost half of all Americans, 49%, abstain completely or drink fewer than 12 alcoholic drinks per year!)⁶

If you choose to drink, to minimize your risk of an alcohol problem:

1. If you are a man, drink no more than 15 drinks per week and and no more than 4 drinks in a sitting and if you are a woman, drink no more than 10 drinks per week and 3 drinks in a sitting
2. Make sure you take days off from drinking each week, to avoid getting into a habit or developing a tolerance⁷

You can further reduce your risk of developing an alcohol problem by:

• Maintaining physical and mental health
• Getting involved in your community
• Building and maintaining social relationships
• Finding and engaging in something that brings purpose and meaning to your life

I’m Addicted to Alcohol – What Do I Do?

Once addicted to alcohol, stopping for good becomes very tough.

If you’ve decided to quit drinking, you need to:

1. Withdrawal (detox) from alcohol safely
2. Get the support or treatment you need to maintain abstinence over time

Detox

Over time, your brain becomes very accustomed to a steady influx of alcohol, and it adapts to handle this – coming to require alcohol for ‘normal’ functioning.

If you suddenly stop drinking, because of the way your brain has changed, you can have very serious physical reactions, such as seizures, that can be fatal.

You may be able to detox without medical supervision, but you should always consult with a doctor prior to attempting a detox on your own. In many cases, you will need medical monitoring and medications during the first few days of abstinence.

Do not try this on your own. Learn more about alcohol detox, be smart, and get the help you need to be safe and comfortable during this tough initial phase.

Ongoing Treatment or Support

Alcohol addiction is considered a brain disease. By the time you develop an addiction to alcohol your brain has changed in irreversible ways, these changes make it tough for you to stay abstinent and they make it very unlikely that you will ever be able to drink in moderation again.

Learn more about how addiction changes your brain.

Once addicted...

1. You become very susceptible to environmental cues that trigger alcohol memories and cravings. Often you won’t even know what triggers you, but something in the environment, a smell, sound or sight can trigger an unconscious memory that results in an intense craving -  as if out of nowhere
2. Changes to the nucleus accumbens make you very motivated to engage in activities that immediately stimulate your reward systems, even at the expense of other activities that promote good long term health and wellness
3. Brain changes in the frontal cortex diminish your ability to delay gratification and resist impulses⁹

So, once addicted, you’re assaulted with cravings that seem triggered almost out of thin air, you’re pushed towards activities that give you an immediate sense of reward and you become less able to resist impulses and delay gratification…no wonder quitting is so tough!

Because of all this, most people require some form of addiction treatment and long-lasting ongoing support to maintain abstinence.

Some examples of addiction treatment include:

• Working with a psychologist, psychiatrist or addictions counselor
• Enrolling in an outpatient addiction treatment program
• Entering an alcohol rehab treatment program

Some examples of ongoing support include:

• An addiction treatment aftercare program
• Community support group participation, like AA or NA
• Sober living housing

Image Copyright: Josep Salvia I Bote

If you had an opportunity to change the present course of your life and you knew you wouldn't have to do it alone would you be interested in knowing more?

Thinking about quitting drinking or drugs? It has been said that the truth will set you free so here are five questions to evaluate your drinking or drug use that only someone concerned about their substance use can answer. Remember--once you know something you can't "unknow" it.

1. Is it true you can stop using any time you want?
2. Is it true no one really gets hurt when you use?
3. Is it true the world is really out to get you?
4. Is it true using helps you get a grip on things when things get out of control? (Does it help you relax and think more clearly)?
5. Is it true family and or friends avoid you when you are around them at a social function?

How did I come by these questions? These are the ones that made me think about what I was doing when I finally was confronted by some people who really cared about me and what was happening to my life.

I understand what it feels like when we finally reach that place where we can't even look at ourselves in a mirror without being frightened and angry both at ourselves and the world we live in. The wheels are falling off and we just can't seem to get a grip on anything long enough to slow it down.

So here are my answers--my real truths--regarding the 5 questions above. After these I'll suggest some things that can happen to make things a bit better.

Confronting the Truth

1. Can You Stop Using any Time You Want?

Can you really stop drinking or drugs?

For me, stopping wasn't a problem--"I've quit a thousand times" is the refrain that is heard during most NA, CA and AA meetings. It's the comeback of choice for those who are scared, angry and beginning to feel hopeless and helpless.

My truth was I really could stop any time I wanted. The bigger problem, however, was I couldn't stay 'quit'. As soon as I got feeling a little better and things started to look a bit different I'd start up again and it wouldn't be long before another crisis was born.

In essence I was just living a life built on a really shaky foundation and I began to see my use as a much greater problem. The REAL TRUTH was that I was not equipped to deal with the outcomes of the decisions I was making and my life, as I knew it, was slipping away from me--it truly was becoming unmanageable. The bigger the problem the more I used.

2. Is It True that No One Really Gets Hurt When You Use?

As a counselor in this field I became aware of the truth that somewhere between 5-10 folks, and more in many cases, are directly affected and seriously hurt by our use and our efforts to deflect or discount what people around us are saying.

• The REAL TRUTH here is that our loved ones, our close friends, our neighbors, our close family members-brothers, sisters, cousins, grand parents and on it goes get hurt by our behavior.
  

When things get serious, and they always do, we will cheat, lie, scam, manipulate and use all the above people mentioned in some way and then justify how and why we did it.

Many people get hurt when we use. This doesn't make us horrible people but it does make us responsible for the decision to stop doing it once we realize what is going on.

3. Is the World Really out to Get You?

The more I lost the more I felt like a victim. Self pity was a regular staple. I never let the consideration or the connection of what I was doing--my lifestyle--and what was happening as a consequence even enter my reality.

I truly felt that nothing and no one understood me and if they didn't then they must be out to get me for some reason or another. Paranoia was a rampant everyday mindset. Why else would all this bad stuff be happening to me? I just needed a break but it never came.

The REAL TRUTH is that most of us are the authors of our own stories and if they aren't pretty then we need to look at what we are doing to contribute to it and begin to change some things. This is hard to do when when we are impaired most of the time. Even if we aren't actively using we can still be mentally and emotionally incapacitated because of the journey we have been on.

4. Does Using Really Help You Relax and Get a Grip on Things?

Using drugs or alcohol to handle feelings? A mistaken belief by many is that 'a few tokes, a couple of shots or a tab or two of this or that will help me to relax and calm down so that I can get a better grip on things'.

I don't agree that this is a viable solution at the best or worst of times. If the situation was one of unspeakable grief I could understand taking something that would dull the pain. The REAL TRUTH is when we take something--a drug of some kind to help us get through things so we can think more clearly, we are actually using to stop feeling anything or having to make some tough choices.

Fear is often a motivating factor and we don't do well feeling fear. Those of us who managed our lives by using something to alter our moods have few life skills or strategies in our 'kit bags' to help us deal with what is going on around us.

Using for me was about employing a coping strategy that I knew would work even though the outcomes of employing that strategy created other problems that I was ill equipped to handle. In other words I just traded one thing for another. I was further behind then when I started out.

5. Do Family and/or Friends Avoid You at Social Functions?

This one was more difficult to deal with than any of the others. When this happened, and it happened a great deal near the end of my run, I truly felt abandoned and disconnected from those whom I cared about the most.

I was embarrassing to be around and those closest to me didn't know how to respond to me any more. Instead they just stayed away from attending any public event I might be at so they wouldn't have to deal with whatever was to come.

I became unpredictable and for those who have kids you might understand how and why they became frightened as well.

Responding to Unpleasant Truth with Life-Change

The good news is there are strategies to consider that can be very helpful in changing all of this for the better - but one thing has to happen first. There has to be a clear, unconditional commitment made to pursue a clean and/or sober lifestyle.

This means that the substance user needs to be ready to make a change happen. He may not know how to do this but we can help with that. This decision cannot be made out of fear of losing the remainder of things but rather a recognition that some things might be gained back that are meaningful but currently not available.

The REAL TRUTH is fear is a poor motivator to ensure long term change. I suggest the following 30 day approach to many clients. Does it work for everyone--no it doesn't. Does it work for many-yes it does. You can be one of the many.

A 30 Day Approach

1. You enlist the help of a close and trusted friend. Most good friends will help if they know their help is given and received as support. This asking for help is often the first step for many substance users in that it can begin the process of re-connecting with those who were important.
   
2. You agree to abstain from using anything not prescribed for 30 days during which time you do whatever you need to do to get through the struggles and the tough times that confront you.
3. Your friend agrees to observe you over those 30 days and at the end he/she is to share with you what they saw and heard from you. For example you might have been agitated at the start but less so a the end of the time.
   
4. At the beginning of the trial run you write a number on a piece of paper from 1 to 10 that represents where on the scale you feel you need to be to say that the quality of your life has improved. You also write a number down that represents where you see yourself now (when you start the process) and put the date beside it. 1 indicates the lowest point and 10 represents the highest point--the best it could possibly be. Then put the slip of paper in your wallet.
   
5. At the end of 30 days you write a number on a separate piece of paper (even though you remember the original number) that represents where you are at that time--30 days later-- and then compare the two. Don't be disappointed by an increase of only one or two numbers. If your new number goes up a notch then that's improvement and that's what you want.
   
6. Ask yourself what you did that was different and may have contributed to increasing the number. Then continue to do what worked for you. Also ask yourself what else could you do to raise the number another notch? If your number at the end of 30 days goes down then that tells you what you tried to do didn't work and other strategies need to be considered.

Either way you win because this exercise is about developing plans that will help you deal with your issues day to day. Of course we hope that what we are doing will move our number up not down. But knowing what doesn't work is also very important because it stops you from putting energy and time into a strategy that isn't moving you closer to where you want to be--stop doing what doesn't work.

KEY POINT: Don't be concerned about how much the number changes and how fast it is changing, rather try to understand why it changed. If you like how things are going and if it feels better than it did before you were abstinent, then you can agree to do another 30 day trial. Ask your friend for their continued support and repeat the process.

As for the other 4 items on that 5 item list a couple of them will begin to take care of themselves as a consequence of not using. The others can and will be dealt with in time.

First there is a need to re-establish an element of trust and that doesn't happen overnight. Can trust be re-established? With the right approach I believe it is possible to re-build far more than you have now--that's for sure.

Please send any questions or comments to me at ChooseHelp.com. Enjoy what I hope will be the beginning of a new way of living with Peace, Prosperity and Happiness!

--- Jim

Addiction is not a choice but life-threatening disease. Unfortunately, many people still believe addiction is a choice - and it's a serious problem.

Addiction is not a choice but life-threatening disease. Unfortunately, many people still believe addiction is a choice - and it's a serious problem. It's this belief that is the foundation for the stigma of addiction.

The Stigma of Addiction

Until people embrace the disease concept, addicted people will be treated poorly by others who believe addiction is a choice. If addiction is a choice, then it follows that the people who make that choice are either bad people or people who make bad decisions. Either way, it doesn't reflect too highly on the addict. That is why the idea that addiction is a choice is the basis of the stigma attached to addiction.

Addiction Stigma Prevents People from Getting Help

As a society, we need to embrace the disease concept! The stigma of addiction makes it less likely people will seek help. After all, who wants to show up at a treatment center or tell their family and friends that they are either bad or make bad decisions?

For more addicts to get treatment, it is imperative that more people accept that addiction is a disease.

The disease concept clearly removes some of the stigma from addiction. If addiction is a disease, how can people look down on someone affected by it? We don't treat diabetics that way or people with other conditions.

Think about the comparison for a minute. Type II diabetes may be caused by overeating and not getting enough exercise. But just like addiction, we don't know for a fact what causes type II diabetes. Imagine that instead of treating diabetics professionally, they faced scorn from the medical community and the general public. How many diabetics would go for treatment if they knew people would blame them for their disease? Not many, I imagine.

This is exactly what happens to addicts on a daily basis. Doctors and other medical staff make assumptions that they are drug-seeking even when the addicted person is actually in pain. Family members and friends aren't supportive because they don't believe there's any hope for the addict. The justice system treats them like they are criminals. And the general public treats them like they are social piranhas.

8 Reasons Why Addiction Is Not a Choice

1. Even if the first time a person takes a drug is a choice, that does not make the person responsible for becoming addicted.
2. The person who becomes addicted doesn't realize they are making a life-altering decision when they take the first drug.
3. Most addictions begin before the brain is fully matured when the brain processes information based on feelings, not logic.
4. After a person becomes addicted to a drug, their brain changes in significant ways.
5. The reward center of the brain is re-wired, so the person is only rewarded for continuing the addiction.
6. Some drugs create extra receptors for the drug, which can lead the addicted person to continue to crave the drug even years after the drug is no longer taken.
7. When a drug is stopped, the addicted person goes through withdrawal. The discomfort of withdrawal keeps many addicts from stopping their drug use.
8. While most people think addicts continue using drugs to get “high,” many drugs have a tolerance level after which the addicted person no longer experiences the pleasurable effects.

With Time, Addiction Sneaks In

I understand how people came to the conclusion that addiction is a choice. When an addicted person took that first drug, it may have been a choice. However, there may be a genetic predisposition and social/environmental factors that led the person to make that choice.

Let's say for a minute that we do accept that addiction and type II diabetes both begin with a choice. With addiction, the choice is to take the first drug or perhaps to take the drug, the person becomes addicted too. With type II diabetes, the choice is to eat too much sugar and carbohydrates and to be inactive.

Keep in mind, the people affected obviously don't realize they are making a life-altering decision at the time. After all, why would anyone choose addiction or type II diabetes? Plus, if you think about it, it's more like they make a lot of decisions that seem small but add to a problem over time.

Type II diabetes isn't caused by one choice. People don't get diabetes because they chose to eat a doughnut one day instead of a salad. It happens because they make a lot of little choices that might not be so bad on their own. But when you add them up, those choices lead to type II diabetes.

It's the same with addiction. People don't become addicted to opiates just because they smoked marijuana when they were 14. It works more like the type II diabetes example. They make a lot of small choices that lead to worse choices and eventually all of those choices lead to addiction. On their own, none of the choices would necessarily make someone an addict. After all, some people who make those same choices don't become addicts.

Indeed, both the people who become addicted and the people who become type II diabetics know the choices are bad when they make them. But they couldn't foresee that those decisions would add up to addiction or type II diabetes. So, is it really fair to blame them for the end result?

Young People Make Poor Choices

On top of all that, the decisions that lead to addiction and type II diabetes often start early in life. Most addictions, as well as poor eating habits and not exercising, begin when people are young adults, teenagers or even younger. People who become addicted rarely start using drugs when they're adults. It's just like most people start eating unhealthy and inactive lifestyles when they're young.

Our brains don't fully mature until we are about 25 years old. Before that, most people make at least a few poor choices because they just haven't developed the ability to reason and think logically the way you can once your brain has fully developed.

We've learned through research that an adult's brain works differently from a young adult, teenager or child's brain. Before age 25, the part of the brain called the amygdala is more active. Adults use the prefrontal cortex more. The amygdala is the emotional part of the brain. The prefrontal cortex is the part of the brain that is responsible for sound judgement and the part that considers the long-term consequences of our actions.

It makes a lot of sense that young people make poor choices when you know they process information based more on feelings than logic and judgement like an adult. If an adult (who has never used drugs) is offered drugs, he or she is more likely to think about how that choice could affect their body, lead to other poor choices and have lasting consequences. Young people are more likely to think about how that drug will make them feel.

If you only think about how a drug will make you feel and you don't think about the long-term effects, it only makes sense that young people are more likely to try drugs for the first time.

When addictions do begin in adulthood, it's rare to find no history of drug use before age 25. And addictions that begin in adulthood are more likely to begin with prescription drugs. It is quite possible for an adult to use reasoning and still make a poor choice when they put too much trust in a doctor. Many people have the mistaken belief that their doctor would only do what is best for them. While this may be true for many doctors, as with any profession, there are bound to be a few bad apples. There are many doctors who are more interested in making money or who just don't care.

The Brain Changes

Even if we accept that the addicted person makes a choice the first time they take a drug that doesn't mean the person is responsible for becoming addicted. At some point, something happens in a person's brain that changes everything. And after a person becomes addicted to a drug, their brain changes in even more significant ways. In fact, once a person becomes an addict, their brain will encourage them to continue their addiction.

The brain will encourage the addict to continue an addiction in many different ways depending on the drug the person is addicted to. One way is that the reward center of the brain is re-wired, so the person is only rewarded for continuing the addiction.

Usually, we get rewarded for survival behaviors like eating and sex. Eating keeps us alive, and sex propagates the human species. Our brains reward us with dopamine for such behaviors that we need to repeat to survive as an individual and a species.

Dopamine makes you feel good, which encourages you to repeat these behaviors. The whole process is a little more complicated than that, but for the purposes of this article, it's important to note that the addicted person is rewarded for continuing the addiction.
With opiate addiction, as the person takes more opiates, the brain makes more receptors for opiates. Opiates fit into the same receptors as endorphins. Endorphins are the body's own natural painkillers. Endorphins take away the pain and leave a pleasurable feeling when they are released.

Because the addicted person has additional receptors for opiates, they will continue to crave opiates to fill those receptors. This continues for a person's whole life. Those receptors never die. That is why an addict can stop using opiates for years and still return to them.
Nicotine addiction works in a similar way. Nicotine is shaped like the neurotransmitter acetylcholine. It fits into the same receptor as acetylcholine. These receptors are called nicotinic acetylcholine receptors.

When nicotine enters the brain, it acts just like the natural neurotransmitter acetylcholine. Both nicotine and acetylcholine affect heart rate, breathing, muscle movement and memory.

Nicotine also increases the amount of dopamine in the brain. Remember that dopamine is the neurotransmitter that makes you feel good so you'll repeat behaviors like eating and sex. Since dopamine is increased by nicotine, the person who uses nicotine is rewarded for using it, which encourages it's continued use.

As you can see, once a person becomes addicted to a substance, their brain changes to accommodate that substance. The body is designed to maintain homeostasis. It regulates functioning to maintain this stability. Temperature is a good example of homeostasis. The body works to keep an average temperature of 98.6. With an addicted person, the body works to maintain the addiction because not doing so would be disruptive to the body.

The Fear of Withdrawal

When a person who is addicted to drugs fights against this and stops taking the drug, their body goes into withdrawal. Withdrawal is painful and uncomfortable for the addict. It can include a variety of symptoms depending on what drug the person is addicted to. But no matter what the symptoms, the discomfort keeps many addicts from stopping their drug use.

The fear of withdrawal can keep many addicted people on a drug long after the pleasurable effects wear off. And the pleasurable effects of drugs don't continue for the person who has been addicted for a long time. Most people probably think addicts continue to use drugs to get “high,” which is what we call the pleasurable effects of a drug. But many drugs have a tolerance level after which the addicted person no longer experiences the pleasurable effects.

Because of tolerance, you can be addicted to a drug that no longer even makes you feel good. Tolerance means you need more and more of a drug to get the same results. Since it is rarely possible to keep taking more of a drug, many addicts will get to the point that they take enough of a drug to avoid withdrawal symptoms.

Cigarettes are a good example of how tolerance keeps the person from experiencing the pleasurable effects of the drug. If you've ever known anyone who smokes, most of them will tell you that smoking doesn't make them feel good.

After years of smoking, most people develop a lingering cough and get out of breath easily. Most people don't even like smoking after they've been doing it for many years. But they'll continue to smoke. They often continue more out of fear of the withdrawal symptoms than any pleasurable effects from smoking.

As a society, we need to embrace the disease concept and stop treating addicted people like they are bad people. The only thing that treating them poorly accomplishes is to keep addicted people from getting the treatment and support they need to recover.

Learn how the brain changes of addiction exacerbate problems with impulsive and compulsive acts – how impulsivity drives early addiction and compulsivity and impulsivity perpetuate later stages and most importantly, what you can do to retake control.

Addiction is a persistent and complex brain disease that’s characterized by a diminished ability to control drug or alcohol use and by episodes of relapse, after even prolonged periods of abstinence.

Has your history of drug and alcohol use caused brain changes?

Well, if so, you’re in good company with millions of other Americans, and though addiction makes behavioral regulation difficult, you can learn strategies to retake control and you can manage the situation so it doesn’t diminish your health and quality of life (there's good cause for hope and optimism!)

To aid in this process, it’s useful to learn all you can about exactly how brain changes lead to addiction, such as how impulsivity and compulsivity team-up as two component pieces of the complex puzzle of addiction.

Understanding Impulsivity

Impulsivity = Acting quickly and without adequate thought or planning in response to internal or external stimuli. A predisposition to accept smaller immediate rewards over larger delayed gratification and an inability to stop a behavior toward gratification once it’s set in motion.¹

A behavioral example of impulsivity could be:

• Running into a friend in the street and accepting a sudden invitation to get drunk/high even though you need to be up early in the morning for an important work presentation.

Understanding Compulsivity

Compulsivity = Behaviors engaged in to ward off negative feelings. These behaviors persevere even in the face of adverse consequences; repeating the same acts over and over again even though they cause negative results. Compulsive behaviors are often habitual in nature.²

A behavioral example of compulsivity could be:

• You feel anxious and tense before work so you feel a strong need to get high beforehand to function normally, even though getting high at work has caused you repeated problems in the past.

Impulsivity Vs. Compulsivity

• Impulsive – Seeking pleasure
• Compulsive – Avoiding pain

Impulsive acts are generally driven by pleasure-seeking – spontaneous or ill-considered actions driven by hedonistic principles and positive reinforcement. You feel arousal or tension in the build-up to the act and pleasure, gratification and release after committing the act.

Compulsive behaviors, in contrast, are driven by a desire or ‘need’ to avoid discomfort and by feelings of anxiety and stress that precede a habitual compulsive act and feelings of relief from stress after committing the act. Compulsive behaviors are habitual and negative-reinforcement driven.¹

Impulsivity and Compulsivity in Addiction

Addiction is considered a brain disease because changes to the brain’s structure and functioning lead to a loss of behavioral control and to using drugs or alcohol even in the face of great personal consequences. The increased impulsivity and compulsivity seen with addiction result from changes to the cortex and to a reduced ability to regulate behavior, override negative impulses and make use of top-down controls to achieve long-term goals in the face of short-term costs. 

Both impulsivity and compulsivity play a role in the development and perpetuation of addiction, though impulsivity is more influential in the first stages of abuse/addiction and then later stages are characterized more by a combination of compulsive and impulsive acts.

Early Addiction – Characterized by Impulsivity

As we repeatedly overload reward and motivation circuits of the brain with excessive dopamine (getting drunk or high repeatedly, over a period of time) these systems can become dysregulated and start to malfunction. Two consequences of this neural dysregulation are:

1. A diminished capacity to regulate impulsivity.
   
2. A broken motivation system that’s been rewired to seek out drug rewards over all other rewards of normal life.

As abuse transitions into the early stages of addiction, you become increasingly focused on getting the pleasures of drugs or alcohol and increasingly unable to resist your impulses to get drunk or high.

So the early stages of addiction develop around pleasure-seeking and the impulsivity that allows for continued pleasure-seeking.

Mid to Late Addiction – Compulsion and Impulsivity

Over time, as the social, physical and psychological consequences of drug or alcohol use mount and as use gets more habitual/ritualized (late-afternoon cocktails), the primary motivation for use tends to shift away from pleasure-seeking (though that’s still there) and toward avoiding the negative consequences of not using (feeling like you don’t just want a drink, you NEED a DRINK!)

In mid to late addiction, periods between use are characterized by increasing withdrawal symptoms, anxiety and stress. By this point, people use primarily to relieve stress, anxiety and physical discomfort, while still also seeking pleasure as a secondary motivation.

Responses to stress and anxiety also become very habituated and you come to feel like you need to drink or use drugs in certain situations/times or else you’ll face negative/unbearable consequences.³

Demonstrating Compulsivity’s Role in Addiction

Recent animal-model research (April 2013) illustrates how significantly brain changes to the prefrontal cortex influence the ability to resist cocaine compulsions.⁴

Just like with humans, not every rat that uses cocaine ‘recreationally’ gets strongly addicted. What protects some rats and humans alike may be differences in the way the prefrontal cortex responds to repeated cocaine use.

The Experiment

1. A group of rats were given 2 months of unrestricted access to cocaine (delivered by the pushing of a lever). All rats became heavy users.
2. After 2 months, the researchers changed the protocol so that pushing the lever delivered cocaine 70% of the time, and 30% of the time it earned the rats a mild electric shock.
3. By 4 days of this new shock protocol, 70% of the rats had stopped trying for cocaine entirely, but 30% of the rats (the addicted rats) continued to seek cocaine, even at the expense of repeated electric shocks.

Why Did Some Rats Continue to Seek Cocaine?

When the researchers looked at the brains of the 2 different groups of rats, they found that the addicted rats had less active neurons in the dorsal lateral prefrontal cortex – an area of the brain that regulates behaviors by inhibiting actions that may have greater negative than positive consequences.

• So though an addicted rat may ‘know’ that pressing the lever could be painful, the brain area that’s responsible for stopping harmful behaviors isn’t working well enough and the rat isn’t able to stop itself.

To further demonstrate the role of brain-damage induced compulsivity in addiction, the researchers were also able to induce addictive behaviors (compulsive use of cocaine even at risk of electric shock) in rats that had previously avoided the shock lever by dampening neuronal firing in the dorsal lateral prefrontal cortex. Conversely, and more significantly, they were also able to extinguish addiction by increasing neuronal activity in that same brain area.

Take Home Message

Some people are far more susceptible to changes in areas of the brain linked to behavioral control and compulsivity. Once these areas start malfunctioning, it becomes very hard to resist compulsive acts. This helps to explain why people continue to take drugs even when they should be able to see that the negative consequences of use outweigh any possible rewards.

Overcome Impulsivity and Compulsivity

The value of addiction treatment….

If you’re already addicted, you might wonder – beyond general interest - what’s the point of learning about mechanisms beyond my conscious control? How can knowing about brain damage help my situation now?

Well, fortunately, though nothing but time will reverse addiction-related brain changes (and some of these are likely permanent) you can learn skills and tools that help you to compensate for your diminished behavioral control.

Addiction alters your brain so you can’t rely on determination and good intentions alone like you once could, but when you learn compensatory skills and tools, you can achieve the same level of behavioral control – and at the end of the day, how you control your behaviors doesn't matter, so long as you can control them.

Most addiction treatment programs focus on teaching compensatory strategies to help people achieve behavioral control. Some examples of these strategies include:

• Learning to recognize cues that trigger impulsive or compulsive impulses. Trying to reduce your exposure to such triggers and learning coping strategies for minimizing  their impact.
• Making a plan for dealing with cravings (when I get a craving I call my sister). This way you don’t have to count on controlling your impulses, you just have to follow your plan.
• Learning strategies to delay acting on your impulses. For example, deciding to delay acting on any impulse to drink or use drugs for at least half an hour (by half an hour most urges dissipate on their own.)
• Learning cognitive behavioral thinking strategies to change the way you think about compulsive urges. For example, “I don’t need a drink I just really want one. I won’t die if I don’t have a drink right now, that’s just my addicted brain trying to get me to fall back into relapse.”
• Learning mindfulness strategies that can help reduce perceived stress and anxiety – by staying in the moment what was unbearable without alcohol becomes manageable sober today.
• Learning to take better care of your physical and emotional health so you’re strong enough to battle your negative impulses. A classic acronym that illustrates this is AA's H.A.L.T. – to avoid succumbing to impulse or compulsion, avoid getting too Hungry, Angry, Lonely or Tired.

Brain changes make it exceptionally hard to stop addiction once it gets a toe-hold. Though determination plays a role, you can’t will-away addiction any more than you could decide to quit diabetes. Fortunately, you can learn strategies that help you to compensate for your diminished capacities – and the millions of people who stay happily in recovery every day are testament to the possibilities of change and a better life.

Image Copyright: Stefan Kohli

Thinking about giving up marijuana but not sure you’re ready to take the plunge? Well, here are 70 benefits of quitting – all first-hand accounts from previously heavy users about how life changes for the better once you don’t need to get high all the time.

Thinking about ditching your marijuana habit?

Well if you’re a heavy smoker you surely know the pros and cons of it and know that though marijuana can be enjoyable, heavy use is not without consequences.

Does your habit give you more or less than it takes? ...Quitting can be tough, but is the payoff worth the effort?

Overcoming ambivalence is an important step toward meaningful and lasting lifestyle change. Quitting marijuana can be hard and there are probably some aspects of your marijuana habit that remain enjoyable. If you’re ambivalent about quitting you probably won’t make it too far in an attempt to break free.

But if after thinking things over you truly believe that a drug-free lifestyle would improve your quality of life you can overcome your ambivalence to change – and once you’re committed to change and willing to do what’s necessary to achieve your goals, you have a much greater chance of success.

So is quitting marijuana worth the effort?

To help you make up your own mind on this very central question, here are some of the benefits of quitting, contributed by people who have managed to quit heavy marijuana habits.

The Benefits of Quitting Marijuana

We found all of the benefits of quitting listed below in personal account posts within internet recovery forums.¹ To see the original posts where these description came from please follow the link in the footnotes below.

In no particular order:

1. Gaining clarity in thinking
2. Becoming more articulate - No longer embarrassed during intellectual conversations with others
3. Noticing an improvement in memory
4. Feeling an increase in energy
5. Needing less sleep
6. Not worrying about getting arrested or having legal problems
7. Not worrying about having to hide a habit from children or family members
8. Having more free time - No longer needing to ‘steal’ all that time from my work, family and hobbies to find time to get high and to find and buy drugs
9. Having more cash - No longer wasting so much money on weed but also no longer wasting so much time high that could have went to productive activities
10. Reduced feelings of anxiety and depression
11. Feeling more able to have meaningful interactions
    
12. More able to cope with stress - More likely to actually deal with problems and sources of stress instead of just getting high – greatly reducing overall stress levels.
13. No more paranoia
14. Feeling more self respect
15. No mindless ‘munchies’ feeding sessions
16. Having clear lungs and being able to breather better
17. Handling mood changes better
18. No longer hanging out with shady drug dealers/supporting organized crime
19. Hanging out with people who are truly friends rather than people who are just people to use drugs with
20. Better personal fitness
21. Having dreams at night again
22. Improved personal appearance
23. Improved sense of smell
24. More patience
25. No more treating those around us badly because we are coming down or in need of THC
26. Feeling truly rested after a good night’s sleep (rather than slightly burnt out)
27. Performing better on the job
28. House is not so messy anymore
29. Improved communication skills
30. Less guilty feelings - No more feeling like you’re lying to people all the time while you’re hiding your marijuana activities and highs
31. No more avoiding people you love because you are too stoned to interact with them
32. Increased openness to emotional experiences
33. Not having to worry about running out of pot anymore
34. Easier to get out of bed in the morning
35. An increased ability to experience simple pleasures in life without needing to be high
36. A better relationship with a romantic partner
37. An improved concentration level
38. More self confidence (able to overcome marijuana habit)
39. More ready to continue with self improvement in other areas of life
40. Increased real creativity (able to produce stuff that makes some degree of sense to other people…not having so called ‘great’ ideas every night that you can’t remember or explain by the morning)
41. Increased possibilities for adventure and growth (doing things other than just sitting around getting high and watching TV or playing computer games)
42. Feeling more in touch with a wide range of emotions and moods, instead of just self medicating with weed all the time to stay ‘happy’ at all times.
43. More able to feel real happiness instead of ‘fake’ happiness
44. Performing better at work, no longer behind on projects all the time
45. No more worrying about whether you still you smell like that joint you smoked not long ago when in public situations. No more worrying about the smell of pot in the house when the doorbell rings unexpectedly. No more panicking when you’re walking down the road high with a sack in your pocket right toward a couple of police officers.
46. Better overall health = getting sick less often
47. No longer rushing to get away from non-smoking friends and loved ones to get home and smoke alone!
48. Don’t have to worry about where and when to get high when visiting with family over the holidays
49. No longer feeling panicked when local supplies dry up temporarily
50. More able to focus in on what you’re doing – and to actually finish something up before moving on to the next thing!
51. Good moods don’t expire as a high wanes down – good moods can last all day.
52. Always ready to respond if needed to an emergency situation (there is nothing worse than having to take a child to the ER while stoned off your head)
53. More able to really fit as a team member at work
54. Able to inspire other people in my life to change unhealthy habits
55. Improved singing voice – tuning guitars with others doesn’t take FOREVER – improvised solos get more creative…can actually remember all the lyrics to songs!
56. Old and long forgotten memories start creeping back into my brain
57. No more needing to worry about the look of my eyes – no more needing to constantly use eye drops
58. More self confidence to stand up for myself (instead of just wanting to escape notice so no would know that I was high)
59. More able to look at what is making me unhappy in my life and working to improve myself – instead of just lighting up for a very temporary solution to my sadness
60. I am more reliable without weed – more likely to finish what I start and more likely to do what I say I will do
61. Feeling less apathetic about things
62. When high didn’t feel comfortable taking classes with other people (social anxiety and paranoia) now can take yoga and other classes to improve myself.
63. Can feel natural highs now
64. Can see better in full sunlight without needing sunglasses
65. Better able to connect sexually with my partner when not high all the time
66. No more scary chest pains
67. No more having to obsess about whether or not I should quit or about the damage my drug use was doing to my relationships and career
68. No more worrying about germs when sharing a joint or a pie with others
69. No more wasting time trying to hook up with a dealer
70. No more dark circles under the eyes all the time

Image Copyright: Bingbing

A drug is a drug, and your body can't tell the difference between what's legal and what's not.

If you abuse over the counter medications to get high, you are at risk for addiction.

High School Kids Get High on Cough Syrup

7% of high school kids in America today report having used Dextromethorphan, the active ingredient in many cough and cold medications, to get high. This easily available over the counter medication, when taken in far larger than recommended dosages, can induce feelings of intoxication and even strong hallucinatory affects.

Dextromethorphan (DXM)

Over the counter drugs containing Dextromethorphan have a low abuse potential (no drug with a high potential for abuse can be sold without a prescription) but when taken in very large quantities, and when taken with frequency, a physical and psychological dependence to the drug can occur. Frequent users can develop a very strong dependence to the drug, and can as well exhibit many harmful symptoms of their drug taking behaviors. For many, the only way to break free from an addiction to over the counter drugs is through participation in an over the counter drug treatment program.

Using information widely available on the internet as a drug taking resource, kids are incredibly savvy about what easily acquired drugs can induce potent intoxications, but although information about the possible dangers of over the counter drugs also exists, many consider over the counter medications a safe way to get high.

Dextromethorphan Detoxification

Some of the physical symptoms of Dextromethorphan withdrawal have been described as similar to heroin withdrawal in occurrence and intensity; and anxiety, nausea, joint pain, nightmares, depression and other symptoms can be expected. Physical addiction causes extreme cravings for the drug, and detox is most likely to be successful if it occurs under medical supervision away from access to drugs. Medically supervised over the counter drug detoxification also allows for symptoms control with appropriate medications, and for medical monitoring to ensure safety during the detoxification period.

Over-The-Counter Drugs Addiction Treatment

Whether the abused drug is cocaine, heroin or cough syrup, the problem that led to drug rehab is both the dependence and a compulsion to use the drug, and as well the underlying motivation towards drug seeking behaviors and abuse. To successfully rehabilitate an over the counter drug addict, both need to be treated.

Detoxification conquers the initial dependence to the drug, but drug seeking behaviors are not extinguished without the inclusion of appropriate therapeutic interventions. Most over the counter drug rehab facilities will incorporate group meetings such as NA or other 12 steps based treatments, cognitive behavioral classes designed to change the thinking and behaviors that lead to abuse, and private sessions with a psychologist or therapist to uncover the basal causes of the drug abuse; as well as to develop a recovery plan designed to encourage sobriety once released from the facility.

Additional programming encourages the healing of the body and spirit, and may include nutritional and vitamin supplementation programs, exercise and sports activities, yoga, and other reflective and meditative educations. Family inclusion in the rehab programming is always beneficial, both to the recovering addict as well as to the family; and is especially important for adolescent abusers.

To enact behavioral change, the drug rehab should ideally provide holistic therapy, and treat the body, mind and spirit as an integral and interconnected whole.

Recovery from over the counter drug abuse does not end with the completion of a drug rehab program, and for the best likelihood of continuing sobriety, participation in long term aftercare is essential.

Whatever the drug of abuse, addiction brings social and physical devastation, and emotional pain; and without appropriate professional intervention and treatment, the probability of long term sobriety is minimal. Any drug addiction or drug abuse should be regarded seriously, and whether the drug is bought on the street corner or in the pharmacy, the end result can be tragically similar.

Addiction to Over-The-Counter Drugs

You may die from an overdose the first time that you try over the counter medications to get high but you are very unlikely to become addicted.

However, if someone using over the counter medications to get high is losing control over their ability to limit their usage amounts or frequency, are increasingly fixated on the getting and using the drug, and continue to use Dextromethorphan despite the occurrence of adverse social or physical consequences, they are very likely addicted.

For people whose regular use has caused the development of addiction, the best way to better the problem is through inclusion in a medically supervised over the counter detoxification, followed by a therapeutic period of over the counter drug treatment rehab.

Dangers of Dextromethorphan Abuse

Although Dextromethorphan is a very safe ingredient when consumed as directed in a cough or cold medication, when this drug is taken in massive quantities there are some very real dangers, including the possibility of a fatal overdose. At high doses, Dextromethorphan can induce heart palpitations, seizures, psychosis and even heart failure. Additionally, many of the over the counter products that contain Dextromethorphan also contain other active ingredients that are dangerous when consumed in larger than recommended dosages. Acetaminophen, while very safe in recommended levels, can induce acute and permanent liver failure when taken at high levels, and many cough and cold symptoms relief medications also contain significant amounts of acetaminophen.

Frequent Dextromethorphan abuse can cause anxiety, abnormal and aggressive behaviors, dizziness, headaches, irritability and a host of other symptoms.

Image Copyright: Curtis Gregory Perry

Learn what increases your risk of Ambien addiction, the particular dangers of use and how to overcome both Ambien dependence and addiction.

Take enough Ambien to get dependent and addicted and you'll change the structure and workings of your brain in lasting ways. That’s the bad news - and that’s why most people struggle when trying to quit.

Fortunately, the brain has an incredible ability to adapt and repair – as long as you give it the healing time it requires.

You can quit and get your pre-Ambien self back again. It may take a little time, but research shows that people who recover from sedative addictions make enormous thinking and psychomotor gains – so happily, the payoff very likely justifies the effort involved.¹

Ambien Addiction vs. Ambien Dependence

To get started, choose which of the following best describes your situation:

1. I am not addicted to or dependent on Ambien
2. I am dependent on but not addicted to Ambien
3. I am dependent on and addicted to Ambien

Not sure? Then read on for a quick explanation of the important differences between Ambien dependence and Ambien addiction.

Ambien Dependence

If you take Ambien as directed (never misusing it) you may become dependent on Ambien but you are unlikely to get addicted to it.

• Your brain adapts to chronic Ambien use by changing the structure and function of certain neurochemical systems.
• Once your brain has adapted in this way, you will experience specific withdrawal symptoms if you suddenly stop taking this medication.

You can also become physically dependent on non-intoxicating drugs like beta blockers – a form of blood pressure medication. However, since these types of drugs have no psychoactive effects (they can't get you high) they, unlike Ambien, are not addictive.

Ambien Addiction

People who misuse Ambien are at risk to become addicted. Examples of misuse include:

• taking more than prescribed
• taking it more frequently than recommended
• taking it for reasons other than what it was prescribed for
• taking it with other drugs or alcohol or taking it recreationally, etc.

At recommended doses you may develop a physical dependency, but you aren’t likely to develop an addiction. This is because at low doses, Ambien doesn’t induce pleasurable intoxication… it only makes you sleepy.

At higher doses, however, Ambien starts to stimulate a wider array of GABBA-Benzodiazepine receptors and it starts to feel a lot like any other benzodiazepine – and since benzodiazepines are extremely addictive, it’s not surprising that higher doses of Ambien can also induce addiction.

Symptoms of Ambien addiction include:

• Losing control over how much you take (being unable to manage your supply between prescriptions, for example).
• Craving Ambien
• Compulsive use, and feeling preoccupied with getting and taking this medication
• Continuing to abuse this drug even though you know you’re doing yourself physical or mental harm

You can be addicted to Ambien without being dependent on it, but in most cases, people addicted to this medication are also physically dependent on it.²

Tapering or Tapering + Addiction Treatment?

Whether you are dependent only, or dependent and addicted, you should not stop taking your pills very suddenly (this can result in dangerous withdrawal symptoms)

1. If you are dependent on Ambien, you will need to gradually taper down your daily dosage
2. If you are dependent on and addicted to Ambien, you will need to taper your daily dosage and you will likely need some form of addiction treatment (to learn to manage your cravings, to learn ways to minimize relapse, to learn better anger and stress management skills, etc.).

In most cases, you can find the treatment you need on an outpatient basis, but people unable to manage a successful tapering program may need residential care and managed dosing, or a rapid detoxification protocol, to achieve successful tapering.

Ambien Dependence – What Happens in the Brain?

The brain is homeostatic – it likes to return to its basic ways of functioning, and if you try to change its functioning through the chronic use of drugs like Ambien, it will adapt in predictable ways to offset the effects of the drugs. When this happens you develop a tolerance and when you start to require a regular dose of your medication just to feel ‘normal’ – you have reached a state of physical dependency.³

Ambien increases the activity of the neurotransmitter GABA in the brain. GABA is an inhibitory chemical that quiets other neurotransmitters in the brain, so by upping GABA, you reduce physical and mental excitement and induce drowsiness and sleep (and at higher doses, reduce anxiety, etc.)

Once dependent, your brain adapts by:

1. Becoming less responsive to GABA (it takes more of it to produce the same results)
2. Becoming less responsive to the medication – it requires more of the medication to up GABA in the brain

So after you develop a dependency, you start to require a certain amount of medication just to maintain normal functioning, never-mind to induce drowsiness.

1. Once the brain adapts to the continual presence of the medication, suddenly stopping causes GABA levels to crash.
2. This causes a corresponding spike in the activity of excitatory chemicals in the brain - it’s as if the brakes came off - and this causes a host of unpleasant withdrawal symptoms.

By tapering down slowly you allow your brain time to readapt to a drug-free state, and you avoid the worst of the withdrawal symptoms.

Although Zolpidem is a very different looking chemical than any of the Benzodiazepines (Xanax, Valium, etc.) they all bind to some of the same receptors (such as GABA A) in the brain.

Ambien Addiction – What Happens in the Brain?

So once Ambien dependent, a person needs to taper down slowly to avoid dangerous withdrawal symptoms.

Problematically, a person who is both Ambien dependent and Ambien addicted is going to have a very hard time controlling their use to manage a steady daily reduction.

Why is this?

Well, in addition to the neural adaptations seen with Ambien tolerance and dependence, Ambien addiction causes a number of additional brain changes and these changes make it very difficult for a person to control their consumption.

Areas of the brain altered by addiction include:

• The frontal cortex
• The amygdala
• The nucleus accumbens
• The hippocampus
• The ventral pallidum
• Others

These structural changes cause:

• Concentration and memory problems
• Intense drug cue-related memories
• A decreased ability to resist impulses
• A hijacked reward system, that causes a strong drive to seek drug intoxication

Brain changes that lead to frequent intense cravings, altered memories and diminished impulse control reduce a person’s ability to manage a tapering plan.

Fortunately, your brain will heal, and while it does, you can compensate by making use of strategies to reduce your exposure to temptation and craving and by learning skills that help you manage cravings that do arise.

You can learn the skills you need in an addiction treatment program.

Is Ambien Addiction the Same as Benzo Addiction?

At low doses Ambien is a more selective GABA-receptor stimulator and therefore may be a medication with less risk of abuse and adverse consequences than the Benzodiazepines (see below).

However, at higher doses, Ambien activates a similar array of GABA-Benzodiazepine receptors as other benzos and causes very similar effects and alterations in the brain.

So for most functional purposes, an Ambien addiction is extremely similar to a Benzo addiction.

• The changes in the brain are similar
• Both types of drugs cause very similar adverse cognitive effects⁴
• Both types of drugs seem to be as risky for older users (both cause a similar increase in hip fractures among the elderly)

Factors That Increase the Risk of Addiction

1. Higher doses

At low-therapeutic doses (within the recommended dosage range) Ambien mostly targets the alpha1 subunit of the GABA A receptors in the brain, and this causes sleep promotion.

At higher doses, Zolpidem also targets the Alpha 2, 3, and 5 receptor subunits. These subunits are those targeted by Benzodiazepines to induce anxiolytic (feel good) effects.⁵

When studying the abuse potential of Zolpidem, researchers found that former drug abusers couldn’t differentiate between the effects 40mgs of Zolpidem and 20 mgs of Diazepam (Valium…a very addictive drug). In contrast, this same group of users couldn’t differentiate between 10mgs of Zolpidem and a placebo pill (no-medication).⁶

So taking higher doses of Zolpidem transforms the medication from one that mostly just makes you sleepy, to one that also makes you feel very pleasantly relaxed. Therefore higher doses of Zolpidem are much more likely to cause addiction than lower doses.

2. Your sex

Women do not metabolize Ambien as efficiently as men and this can result in plasma concentrations that are as much as 50% higher than an equivalent dose/kg for men.

3. A history of drug abuse or alcoholism

4. Heavy alcohol use

5. Psychiatric illness⁷

Ambien and Increased Risk of Premature Death?

If you abuse Ambien your life will likely improve after you stop using and give your brain a little time to heal and revert back to normal functioning.

But if that’s not enough incentive to get you moving, would an increased risk of early death scare you into action?

In a correlational study published in BMJ Open, researchers found that even after controlling for factors like pre-occurring disease, people prescribed sedatives like Ambien were far more likely to die over a 2.5 year study period than matched control subjects.

1. People prescribed 18 or fewer pills per year were 3.6 times more likely to die over the 2.5 year period
2. People prescribed between 18 and 132 pills per year were 4.43 times more likely to die
3. People prescribed more than 132 pills per year were 5.32 times more likely to die⁸

Particular Risks for Women

In January of this year (2013) the FDA ordered a reduction on the recommended dosage of Zolpidem for sleep disorders.

Under these new guidelines, women are advised to start with 5 mgs of the instant release or 6.5 mgs of the extended release formulation.

Women metabolize and eliminate the drug more slowly than men, and at higher doses, especially for women, there is a significant risk of next-morning impairment and next-morning impaired driving.

Worryingly, next-morning impairment, such as decreased alertness, can often go unnoticed, since it can occur even when users don’t feel especially sleepy.

Are you at risk of a morning accident?

If you’ve been using Zolpidem for a while, you’re very likely using more than 5 – 6.5 mgs per night, and thus you may be at risk of next-morning driving impairment.

Image Copyright: Demandaj

Wondering about your use of Ativan (lorazepam) or any other benzodiazepine? Well then, take this 2 minute benzodiazepine addiction self test and find out if you have an addiction, and if so, how serious it is.

Ativan (Lorazepam), like all the benzodiazepines, is extremely addictive.

It’s not recommended for long term use (not for more than 2 to 4 weeks). The longer you use it and the higher your daily dose climbs, the more dependent you become - and as your daily dose goes up, so too does your risk of negative side effects: like memory disruption, thinking problems and over-sedation.

Have you been on Ativan for a while? Wondering if you’re maybe addicted or know you’re addicted but not sure how serious things have become? Well, read on then and take this very quick and easy self test to find out.

Ativan Addiction Facts

• In some cases, people experience withdrawal symptoms after having used at therapeutic doses for as little as a week.
• Ativan is not designed for continuous long term use - In general, using any benzodiazepine for longer than 2 to 4 weeks increases your risk of addiction and withdrawal problems.
• Ativan quickly loses its effectiveness as a sleeping aid (due to tolerance development) and there is no evidence that Ativan helps with anxiety after 4 months of continuous use.¹

• Once dependent, you need to slowly taper down your daily dosage to minimize withdrawal symptoms. A cold turkey detox is dangerous and very needlessly uncomfortable. Make sure to read the complete guide to safe benzo tapering before you even think about getting started.

Benzodiazepine Addiction Self Test²

The following self test is based on the Bendep-SRQ (SV), which is a clinically proven valid and reliable instrument to measure for the presence and severity benzodiazepine dependence.³

Consider each statement and then beside it:

• If you feel you that it not true for you, make a check-mark in the Not True column.
• If you feel that it is partly true, true or absolutely true, make a check-mark in the True column.
  

Interpreting the Results

OK, for your scores:

1. A check mark in the Not True column equals a 0 score
2. A check mark in the True column equals a 1 score

The results of this test will reveal your addiction severity across 3 measures:

1. Problematic usage (the severity of problems caused by Ativan usage)
2. Preoccupation (how focused you are on getting and taking this medication)
3. Lack of compliance with your doctor’s instructions

High scores in any one subset indicate the presence of an addiction. High scores in all subsets indicate a severe addiction.

Problematic Use

Add up your scores from questions 3, 6, 8, 10 and 13

If you score:

• 0, you have very low problematic usage
• 1, you experience moderate problems from your use
• 2, you experience a high degree of problems from your usage
• 3, 4 or 5, you experience a very high level of problems from your usage

Preoccupation

Add up your scores from questions 1, 2, 5, 11 and 12

If you score:

• 0, you have no or a very low preoccupation with Ativan
• 1, you have a low preoccupation
• 2, you have a moderate preoccupation
• 3, you have a high preoccupation
• 4 or 5, you have a very high preoccupation

Lack of Compliance

Add up your scores from questions 4, 7, 9, 14 and 15

If you score:

• 0, you have no or low non compliance issues
• 1, you have a high degree of non compliance
• 2, 3, 4 or 5, you have a very high degree of non compliance

Image Copyright: Dean812

People who use cocaine have an increased risk of heart attack, stroke and other forms of heart disease. Cocaine causes high blood pressure, can cause cardiac infections, causes the heart to work harder as it shrinks blood vessels, can lead to an enlarged and weakened heart and to a host of other cardiovascular conditions. The chronic use of cocaine can lead to serious damage, but most scarily, cocaine can lead to heart failure even after a first experimentation.

Although the dangers of cocaine addiction are pretty well known, cocaine users may be less aware of the damage cocaine can do to the heart.

Cocaine can cause heart failure the from the first time you use

The chronic use of cocaine can damage the heart and lead to an increased likelihood of heart attack, stroke, or death from other cardio pulmonary conditions

Cocaine is such a risk factor for cardiac incidents that emergency room doctors are urged to ask about recent cocaine use whenever heart attack symptoms present in a non typical patient (Too young, no history of heart disease, no familial history of heart disease etc.)¹

What Are the Odds?

Researchers at Institute for Prevention of Cardiovascular Disease in Boston studied interview data from almost 4000 men and women who had suffered a non fatal heart attack. They found that:

People have a 2400% increased chance of having a heart attack within 24 hours of using cocaine and that amongst the study subjects, cocaine users seemed to have heart attacks decades younger than non cocaine users.²

What Does Cocaine Do to the Heart?

Cocaine affects the cardiovascular system in a number of ways. Cocaine’s effects can cause immediate (dangerous) changes in cardiac function and cocaine can also cause lasting damage when used chronically.

Cocaine can cause heart damage in a number of ways, such as:

• Cocaine causes blood pressure to rise after ingestion – which can lead to stroke or ruptured blood vessels in the brain
• Cocaine causes a thickening of the blood vessels which results in diminished supply of oxygen to the brain and muscles. Cocaine also causes the heart to beat more quickly, which compounds the stress and can lead to heart attack or stroke³
• A cocaine overdose can lead to sudden heart failure
• Cocaine can lead to an inflammation of the heart muscle (myocarditis) or of the heart lining (Endocarditis)
• Cocaine can cause fluid to gather in the lungs (Pulmonary edema)
• Cocaine can lead to clots in blood vessels (thrombosis)
• The chronic use of cocaine can lead to an enlarged and weakened heart (dilated cardiomyopathy).⁴

Image Copyright: Bored-Now

Used to treat ADHD, when abused, Ritalin is very pleasurable and also very addictive. Thousands of people suffer addictions to Ritalin, and no matter how they got addicted, they deserve treatment to help them get better.

Ritalin is a drug used to treat the symptoms of ADHD in children and adults. It offers symptoms relief to those who suffer from hyperactivity. Ritalin abuse can result in addiction and syndromes of withdrawal when stopped.

Why Ritalin Can Be Addictive

Ritalin works by increasing the dopamine output in the brain, which helps to improve concentration. Dopamine is also the neurotransmitter very much associated with reward and pleasure in the brain, and for this reason when Ritalin is taken in higher than recommended amounts it can result in euphoria. Anything that causes a psychotropic reaction (a high) can result in a psychological addiction, and Ritalin is no different.

Patients with ADHD who require Ritalin therapy are given the medication in gradually increasing dosages to slowly and steadily build up base levels of dopamine in the brain, and when this process occurs over time and in a controlled manner, there is no intoxication, and there is no risk of addiction.

Addictive if Abused

When people take the medication for non clinical reasons, they tend to take a higher dosage, do get high, and with prolonged abuse do find themselves addicted. Adults and children taking the medication for a legitimate medical condition, and following a doctor's recommendations for dosage amounts and frequency, have little to worry about.

Adults prescribed Ritalin sometimes do experiment with higher doses, and there have been thousands of cases where parents may also take and abuse their children's medications. Although not as potent as a strict amphetamine, the abuse of Ritalin can be quite pleasurable, and is also associated positively with weight loss, and as such can be quite tempting.

Ritalin Withdrawal Symptoms

Once a person becomes addicted to Ritalin, when they try to stop taking the drug, they will experience a syndrome of withdrawal symptoms. These symptoms of withdrawal include:

• Tiredness
• Anxiety
• Depression
• Lethargy
• Hunger
• Cravings
• Others

The withdrawal and detox off of Ritalin presents very similarly to other psycho stimulants like crystal meth and cocaine, and the symptoms are predominantly internal and psychological in nature. Detox can best be accomplished in a facility away from access to the drug, and with the prescription of appropriate psychiatric medications; medications that can take the edge off the depression and anxiety.

Ritalin Addiction Treatment

Following detox, most people who have abused and become addicted to Ritalin will require a period of therapy and education. They need to learn what in them cause's drug seeking behaviors, learn how they can avoid future temptations and cravings, and learn why they don’t need to get high to enjoy their lives and families.

A lot of people, especially parents who have abused the mediation, feel great shame for having done so, and these feelings of shame can stop them from getting the help they need to get better. It doesn't matter how you got addicted though, once you are you need to face up to your problem, get the help you deserve, and move on to a better life free from addiction and abuse.

You Can Get Better

Everyone in a drug treatment program has done things that they are ashamed of, and all of us just have to move past this if we want to get better and be better for our families.

If you need some help, have the courage to enter into treatment, have the courage to be a better parent and have the strength to move beyond the legacy of addiction. You can do it, you may need some help, but it's always worth it.

Image Copyright: FGMG

According to self-report data taken from the National Survey on Drug Use and Health, the more often you smoke marijuana, the more likely you are to self-report problems stemming from that use.

Self-Reported Problems from Marijuana Use

According to self-report information provided by marijuana users of varying frequencies, the odds of experiencing problems stemming from marijuana use, not surprisingly, increases with more frequent use. By comparing the problems faced by those who smoke daily with those who smoke once or twice a week you can see clearly how frequency of use plays a major role in likelihood of problems and how moderation or abstinence is a more sensible course of action.

Comparing the problems caused by marijuana use between daily, and once or twice a week users of the drug:¹

• Because of their drug use, daily marijuana smokers were almost twice as likely as weekly (once or twice as week) marijuana smokers to self report feeling depressed or losing interest in things in life, 12.6% compared to 6.6%
• Daily users were almost twice as likely to report feeling alone or isolated, 6.1% compared to 3.1%
• Daily users were more than twice as likely to report feeling suspicious and distrustful of others, 8.4% compared to 4.1%
• Daily users were more than twice as likely to report feeling irritable and upset, 5.5% compared to 1.9%
• Daily users were more than three times as likely to report having difficulty handling problems in life, 5.5% compared to 1.5%
• Daily users were more than three times as likely to report having health problems stemming from their use of marijuana, 3.1 % compared to 0.9%
• Daily users were more likely to find it difficult to think clearly, 19.9% compared to 14.3%

Image Copyright: Anael Raziel

Is MDMA addictive? Does it actually do you long term harm? How do you know if you have a problem? Read on to find the answers to these questions and more.

“Occasionally in life there are those moments of unutterable fulfillment which cannot be completely explained by those symbols called words. Their meanings can only be articulated by the inaudible language of the heart.”

- Martin Luther King, Jr.¹

MDMA is a controversial substance. Some say it’s addictive some say it isn’t. Some say it’s harmful, others say it’s not… who to believe?

If you’re wondering about your MDMA habit and thinking about making some changes, read on to learn more about what you’re up against and how to find the success you’re looking for.

Is Ecstasy Addictive?

Maybe…

There is no research that conclusively proves its addictiveness.

However, there is some evidence that indicates that it could be, such as:

• Animals will self administer MDMA – and when animals are willing to take a substance, that usually means it has some dependence potential
• MDMA administration activates many of the same neurochemicals and areas of the brain as other addictive drugs do²

Case studies also show that some people become obsessed with MDMA and experience symptoms of addiction, such as:

• Taking more MDMA than they had intended on
• Craving MDMA
• Continuing to use MDMA even when it causes problems³

Additionally, ecstasy is often mixed with secondary substances, many of which are known to be addictive.

What you buy as ecstasy may also contain:

• Caffeine
• Amphetamines
• Ephedrine
• Dextromethorphan
• Paramethoxyamphetamine (a very dangerous impurity)
• LSD
• Ketamine

So in some cases, you may think you’re addicted to ecstasy, but you’re actually addicted to a substance like amphetamine that is mixed in with the MDMA – and according to the European Monitoring Centre for Drugs and Drug Addiction, there has been a shift over the past few years toward lower MDMA purity and greater adulteration in tablets bought across the continent.⁴

So what does all this mean for you?

Whether or not you’ve been taking pure MDMA and whether scientists can agree on its abuse potential is of little importance to you if you’ve developed a problem with the drug.

It comes down to…

If your drug use is causing you life-problems then you have a drug abuse problem and if you are unable to stop or control your use (and you want to) then you should consider some form of professional addiction treatment.

Are You Addicted?

Having a hard time controlling your drug use (ecstasy, ecstasy plus another drug, or other drugs entirely)?

Wondering if you might be addicted?

If so, ask yourself the following questions to see whether your habit meets the criteria for dependence.

Based on your drug use over the previous 12 months, answer yes or no to the following:

1. Have you built up a tolerance?
2. Do you feel withdrawal symptoms when you don’t take your drug of choice or do you need to take another similar drug to avoid feeling withdrawal symptoms?
3. Do you often take more of the drug than you had intended on using or use for longer than you had intended on?
4. Do you feel a persistent desire to cut down, or have you tried and failed to cut down your drug use?
5. Do you spend a lot of time getting drugs (or the money you need to buy drugs) using drugs and recovering from your use?
6. Because of your drug use, have you given up or reduced the time you spend on other important activities (like school, work, family activities etc.)?
7. Do you continue to use your drug of choice despite knowing that it causes you some persistent physical or psychological problem(s)?

If you answer yes to 3 or more based on your drug use over the previous 12 months you meet the American Psychological Association’s diagnostic criteria for addiction.⁵

Health Consequences of Chronic MDMA Use

Similarly to how experts vary in their opinions of MDMA’s addictiveness, there is a similar difference of opinion about the drug’s long term health consequences.

Some research indicates a link between heavy ecstasy use and increased rates of mental illness and decreased cognitive functioning. Research has also shown a link between heavy MDMA use and chronic exhaustion, muscle aches, sleeping problems and even psychotic symptoms, like flashbacks and delusions.⁶

But critics of this correlational research argue that there is little proof that MDMA actually causes any long-term mental illness or thinking problems, and that in the vast majority of studies, the subjects tested had also used other drugs and alcohol as well in addition to MDMA...which makes it impossible to say with any certainty which substance causes what effects.

We do know, however, that each time you take MDMA (and whatever else might be lurking hidden within a tablet’s chemical mix-up) you are putting your body at risk of acute toxic consequences – some resulting directly from the ingested chemicals, and some from the hyperthermia and other physiological changes that occur after ingestion.

So it’s a little like Russian roulette, in that the more times you take MDMA, the greater your odds of eventually having a serious adverse reaction (in 2008, 17 865 people went to an emergency room after taking ecstasy. The common complaints were hyperthermia, tachycardia, hypertension and anxiety attacks.)⁷

The most common serious adverse reactions include:

• Hyperthermia – Overheating can lead to organ damage and eventually kidney or heart failure
• Strokes and Seizures – Increased body temperature and increased heart rate and blood pressure can cause strokes and seizures
• Serotonin Syndrome (can be fatal)
• Coma and Convulsions – Drinking too much water can lead to electrolyte imbalances that can cause delirium, confusion, convulsions, coma and death

What about Long-Term Thinking Problems?

Although many studies have linked MDMA use to impaired memory and thinking problems, and though we can see that large doses of MDMA seem to harm the functioning of serotonin neurons in the brain, human cognition studies have been plagued by the pesky and problematic reality that users of MDMA also tend to be users of other drugs, like alcohol, marijuana and opiates.

• A more recent National Institute of Drug Abuse backed study compared subjects who used MDMA only to matched control subjects. In this study, MDMA use caused no cognitive deficits.⁸

Making a Change

• Is MDMA addictive? Maybe…
• Does it do you long term harm? Maybe…
• Do you know yourself if your drug use takes more than it gives? You probably do.

When it comes down to the big decisions of life, things tend to get pretty simple (though simple doesn’t always mean easy…)

If you think the costs and risks of MDMA outweigh the benefits, then you should stop using, and if you can’t stop on your own, then you should get the help you need.

Image Copyright: Dima Bushkov

If you’re looking for a good reason to stop abusing tramadol, read on here for an overview of how tramadol works in the brain and the risks associated with chronic abuse, such as addiction, lowered sleep quality, neonatal abstinence syndrome, medication overuse headache, seizures and more.

This is the third installment in a series of articles on tramadol. Also read part 1 - Tramadol Withdrawal and Tapering Guidelines and Part 2 – Tips on Coping with Tramadol Withdrawal Symptoms.

How harmful is tramadol abuse – what’s it really doing in your body and are you going to suffer long-term physical health consequences from your habit?

If you’re a chronic user, you’ve probably wondered about the dangers, so read on to learn more about what tramadol does in your brain and body and about the health risks associated with acute and chronic use, specifically:

• How tramadol works in the brain.
• Tramadol’s addiction potential and how it compares to drugs like oxycodone.
• Seizure risks and what exacerbates these risks.
• Overdose signs and treatments.
• Serotonin syndrome signs and treatments.
• Tramadol and neonatal abstinence syndrome.
• Tramadol’s effects on sleep, its negligible cancer profile and the potential for organ damage.
  

How Does Tramadol Work in the Brain?

Though reading the complex neuroscience behind tramadol can be tough slogging, it’s a good idea to gain at least a basic idea of what it’s doing in your brain. Here's a very brief overview of the medication's 2 primary modes of action.

Disconcertingly, scientists don’t have a total understanding of how tramadol works. Consider this quote from the medication insert, “Tramadol hydrochloride is a centrally acting synthetic opioid analgesic. Although its mode of action is not completely understood.” !!! ¹

But here’s what is known:

Tramadol influences 2 primary brain systems:

1. The opioid system - by binding with u-opioid receptors.
2. the monoamine system - by inhibiting the reuptake of serotonin and norepinephrine.

Tramadol is partially metabolized in the liver by the enzymes CYP2D6 and CYP3A4. The tramadol metabolized by CYP2D6 becomes a substance called O-Desmethyltramadol. Both the original tramadol compound and O-Desmethyltramadol stimulate u-opioid receptors in the brain, though the O-Desmethyltramadol has 6 times the affinity for these receptors than the original compound.

For analgesia (and intoxication) both the opioid and serotonin/norepinephrine systems are important. We know this becasue blocking opioid receptor activation with naloxone does not completely eliminate analgesia or abuse potential.

The Acute and Chronic Risks of Tramadol Abuse

Though tramadol isn't as risky or harmful as full-agonist opiates, with short or long-term abuse you are at risk of some serious health consequences.

Addiction

If you take tramadol chronically you will develop a physical dependence and will experience withdrawal symptoms should you stop taking the drug too suddenly.

You are also at risk of addiction, which is distinct from physical dependence - especially if you ever take more tramadol than prescribed for pain management or if you ever take tramadol just to feel good.

Symptoms of Tramadol Addiction Include:

• A loss of control over your tramadol use (for example, being unable to manage your supply of medication to last between prescriptions).
• Compulsive use.
• Using tramadol for non-medical reasons (to get high).
• Continuing to use tramadol despite being aware that it does you harm or risks you harm (examples could include excessive financial harms, risks of overdose, a failure to meet responsibilities, legal problems, etc.)
• Craving tramadol.²

Tramadol was originally touted as a drug with significantly less abuse and addiction potential than comparable full-agonist opioids. While it’s still considered less addictive than full-opioids, the FDA now acknowledges tramadol’s abuse risk and advises against prescribing this drug to people considered addiction prone or those who use alcohol to excess.

If you think you’re addicted, Self-Test Your Addiction Severity and learn about why you might benefit from addiction treatment.

Study: Comparing Tramadol’s Abuse Risk to Oxycodone’s

In a study of abuse potential, researchers at the University of Kentucky College of Medicine compared tramadol, codeine, oxycodone and a placebo to see how much drug abusers liked each substance (they didn’t know what they were taking) and to see how hard they would work for further doses.

For the study:

• All subjects were non opiate-dependent recreational opiate abusers.
• To test the 3 different drugs, all subjects came in for 7 times for 2-day experimental procedures. On each day 1, researchers gave each subject one of the 4 substances; the subjects then rated this drug for recreational likeability and learned they’d be working the next day to earn doses of this substance.
• On each day 2, subjects came back in and worked (through button clicking exercises) to earn small doses of the same drug.

The Results:

• Subjects did not like the placebo and would not work for it.
• On a scale to 100, when rating how much they liked the pleasurable high, subjects gave 40 mg of oxycodone a score of a little more than 62, 200 mg of codeine a score of 49 and 400 mg of tramadol a score of 47.
• Though subjects reported liking the oxycodone high more than the tramadol high, subjects were willing to work harder to get more tramadol than they were to get more oxycodone or codeine.³
  

The Significant Risks of Seizure

High dose tramadol abuse is associated with a significant risk of seizure. Consider the following studies which illustrate the dangers.

The Belgrade Study

Researchers at Belgrade University Medical School followed a group of 57 tramadol abusers/addicts over a three year period.

• Over that three year period, 31 subjects (54%) had at least one serious seizure – 17 of them had multiple seizures over that period and 14 had a single seizure.
• Doses prompting seizures ranged from 250 mg to 2500 mg and the vast majority of seizures occurred within 24 hours of acute intoxication.
• Factors that increased the risk of seizure included: a longer history of tramadol abuse, younger age and the concurrent use of alcohol.⁴

The Baghdad Study

Out of 41 patients referred to the addiction unit of the Ibn-Rushed Mental Teaching Hospital, 20% had experienced at least one tramadol related seizure.⁵

The Iran Study

And in a review of cases from Baharloo Hospital Poison Center in Iran, out of 401 patients admitted for tramadol overdose, 30.2% reported a history of seizures.⁶

Who Is Most at Risk of Seizure?

People who take more than the recommended daily dose of tramadol are at greater risk of seizures (though seizures can occur within the recommended dosing range). You are also at higher risk of tramadol-induced seizures if you are/have:

• Epilepsy.
• A history of seizures.
• Undergoing alcohol or drug withdrawal.
• A history of head trauma.
• CNS infection or metabolic disorders.⁷

Managing Tramadol Seizures

Tramadol seizures can be managed with diazepam (Valium).

Overdose: Symptoms and Treatments

Tramadol can be lethal in very high doses. For adults, the estimated lethal dose ranges from between 3 and 5 grams.⁸ The lethal dose is lowered when taking tramadol concurrently with other CNS depressants, like alcohol or other sedatives, and overdose deaths have occurred from combinations of CNS depressants and tramadol.⁹

Most of the toxicity associated with tramadol overdose stems from excessive serotonin, and norepinephrine reuptake inhibition…too much tramadol results in too much serotonin and norepinephrine in the brain.

Tramadol overdose symptoms include:

• CNS depression - lethargy and coma.
• Seizures.
• Serotonin syndrome - tremor, muscle rigidity, agitation, hyperthermia, etc.
• Tachycardia and hypertension.
• Respiratory depression (less common).
• Nausea and vomiting.
• Anxiety and agitation.

Overdose Treatment

Since tramadol overdose is potentially lethal, it’s obviously a medical emergency that demands immediate hospital attention. Some possible tramadol overdose treatments include:

• Activated charcoal (but only after recent tramadol ingestion).¹⁰
• Benzodiazepines - for seizures.
• Naloxone for respiratory depression or coma - though this is tricky, since naloxone increases seizure risk.
• Assisted breathing.
• The symptomatic treatment of serotonin syndrome symptoms, such as cooling the body, maintaining hydration, sedating muscles and mind, etc.

Serotonin Syndrome

Tramadol is a mild serotonin reuptake inhibitor, so taking tramadol causes an upswing in neural serotonin levels.

If you take tramadol together with another drug that also increases serotonin levels, like SSRI/SNRIs, MAOIs, dextromethorphan (a cough syrup ingredient), Demerol and others - or with illicit drugs like MDMA or LSD, you risk bumping your serotonin to dangerous levels and experiencing a possibly lethal condition known as serotonin syndrome.

Symptoms of serotonin syndrome include:

• Agitation.
• Nausea and vomiting.
• Rapid heartbeat, high blood pressure and rapid changes in blood pressure.
• An elevated body temperature.
• Heavy sweating.
• Overactive reflexes.
• A loss of coordination and twitching muscles.
• Hallucinations.
• Confusion.
• Headache.
• Shivering.
• Diarrhea.¹¹

Symptoms of severe serotonin syndrome include:

• Seizures.
• Unconsciousness.
• Irregular heartbeat.
• High fever.¹²

Symptoms generally appear within minutes to hours after taking one or more serotonin raising medications.

Serotonin Syndrome Treatment

Serotonin syndrome is a possibly lethal condition that demands immediate medical attention. With appropriate treatment, symptoms will usually dissipate within 24 hours.

Typical treatments include:

• Benzodiazepines.
• Serotonin blocking drugs.
• I.V. fluids.
• Temporary induced muscle paralysis and assisted ventilation (in severe cases).

Tramadol’s Influence on Sleep

Tramadol significantly disrupts sleep quality in non-dependent or tolerant subjects.

• In a sleep study, healthy volunteers given 100 mg of tramadol experienced increased light stage 2 sleep and significantly decreased slow-wave sleep (stage 4) and REM sleep (stage 5).¹³

Chronically reduced deep and REM sleep could impair health and well-being:

• During slow wave sleep blood flows away from the brain and into muscle tissue, the body builds muscle and bone, the immune system is strengthened and the body repairs damaged tissues, such as those damaged by ultraviolet rays.
• Areas of the brain which control emotion, decision making and social functioning go dormant. Sleep scientists think this decreased activation while sleeping helps us maintain maximal social attention and functioning while awake.
  
• Deep sleep may also play a role in learning and memory encoding.¹⁴

Of course, everything depends on your individual situation. For example, if tramadol provides analgesia that increases sleep likelihood, it may have a net-positive impact on sleep quality and quantity.

Cancer and Organ Damage

There is no evidence from animal-model studies that chronic tramadol use increases human cancer risk.

Because tramadol is not associated with an increased cancer risk, or with gastrointestinal, renal or cardiovascular complications, it is considered an appropriate (safe) medication for chronic pain treatment.¹⁵

It is not, however, totally benign. Researchers who compared the long term use of tramadol to morphine in an animal-model study concluded that though tramadol was far less toxic to the liver and kidneys than morphine, it still did some damage over time.¹⁶

Use during Pregnancy/Nursing

Tramadol may slightly increase birth defect risks if used during the first 2 months of pregnancy.

If used during pregnancy, especially chronically or in high doses close to the expected date of delivery, the baby may be born with neonatal abstinence syndrome (NAS).¹⁷

Tramadol is passed through breast milk to your infant. Talk to your doctor before using tramadol while nursing.¹⁸

Medication Overuse Headache

The daily use of tramadol can cause medication overuse headaches.¹⁹

Drug abuse test: do you have a substance use disorder? Well, if you’re not sure, answer the following 2 questions honestly and find out – 92.3% of people that can answer no to both questions do not have a problem.

Here’s a terrifically quick and easy drug abuse test that you can use to check yourself for a substance use disorder. It’s designed to be used by doctors during examinations but you can use it on yourself, or ask the questions to someone you care about, and in seconds learn your odds of having a current substance use disorder.

The Two Item Drug Abuse Test

This test is called the Two Item Conjoint Screen for Alcohol and Drug Disorders.

Answer each question about your behaviors over the previous 12 months.

1. Over the last 12 months, have you ever drunk or used more drugs than you meant to?
2. Over the last 12 months, have you ever wanted to cut down on your drinking or drug use?

Scoring

According to research published in The Journal of The American Board of Family Medicine:¹

• If you answered yes to one or more questions you may have a substance use disorder and should continue to investigate your situation.

What does your score really mean?

Well, when measuring the test's predictive power, researchers found that:

1. Of people that responded with no positive answers, 7.3% actually had a substance use disorder. This means that the test correctly identified people with no positive answers as not having a substance use disorder 92.3% of the time.
2. Of people that answered yes to only one of the two questions, 36.5% actually had a substance use disorder.
3. Of people that answered yes to both questions, 72.4% actually had a substance use disorder.

So if you answered yes to both questions, there’s an almost three in four chance that you have a substance use disorder.

If your test results indicate a possible or likely substance abuse problem, try these additional tests which may offer more insights:

• The APA’s addiction test (7 criteria).
• The addiction severity test – how serious is your addiction?
• The TWEAK alcohol abuse screening test (for women).

Early Intervention Benefits

If your test results (or other test results) indicate a possible or likely problem – what should you do?

Well, you have a number of options, but ‘doing nothing’ is probably the worst decision you could make.

• Substance use disorders occur along a continuum of severity, and with time and continued drug or alcohol abuse, most people progress from mild to more serious disorders.
• Substance use disorders are quite easily treated in the early stages. You might not require any treatment at all (just self-directed behavioral change) nor would you necessarily have to choose abstinence as your only option.
• Treating later-stage substance use disorders is far more difficult. Addiction-related changes to brain function and structure make abstinence the only workable option for most people and long-term damage to mental, physical and cognitive health can compromise your recovery abilities and quality of life.

Education is the key – learn about substance use disorders and about how addiction changes your brain and make smart decisions today to protect your health and happiness for tomorrow and the rest of your days.

To begin your reading, learn the basic facts about addiction.

Can you get addicted to marijuana? Many dispute its existence but experts say marijuana addiction is very real. Read the supporting evidence and then decide for yourself.

Marijuana addiction - is cannabis really addictive?

Although many people still dispute its existence, most medical and addiction treatment groups now acknowledge that marijuana addiction is a real condition that affects about 9% of marijuana users.

Do you believe that marijuana is potentially addictive?

Well, if you don’t, read the following five arguments that support the concept of marijuana addiction and see if the evidence changes your mind.

Note

Since marijuana has become such a polarized and politicized discussion, it’s easy for people on both sides of the issue to overstate claims (it’s a killer!…it’s a panacea!) and to see things in very black and white terms.  We try to present the shades of gray – where the truth probably resides. At ChooseHelp we are anti drug war and anti prohibition but pro treatment and very much pro compassion.

What Is Addiction?

Wikipedia:  Addiction is the continued repetition of a behavior despite adverse consequences, or a neurological impairment leading to such behaviors.

So when we discuss the evidence for marijuana addiction, what are we talking about exactly – what is addiction?

Well, according to the American Academy of Addiction Medicine:¹

• Addiction is a brain disease that affects your reward, motivation and memory circuits.
• Dysfunction in these circuits leads to an unhealthy or pathological drive for reward (such as by getting high).
• Characteristics of addiction include cravings, an inability to consistently abstain or control your use-related behaviors (assuming you want to), a decreased ability to recognize how your use causes life or relationship problems and dysfunctional emotional responses.

Evidence to Support Marijuana Addiction

1. Scientists can see that marijuana stimulates the brain’s reward centers in ways that closely mimic other addictive drugs (through dopamine release in the limbic pathway).³
   
2. Animal studies show that animals display withdrawal-pattern behaviors upon sudden abstinence after chronic THC administration
3. Heavy users will develop a tolerance and require greater amounts to get high. This is similar to what is seen with other addictive drugs.⁴
4. There is research and clinical evidence showing that some heavy users will experience a recognizable set of withdrawal symptoms along a predictable timeline after cessation of use. Some researchers have compared the severity of marijuana withdrawal symptoms to those of nicotine withdrawal from quitting cigarettes.⁵
5. Scientists have observed that approximately 1 in 10 (9%) of marijuana smokers will become addicted at some point in life. For those who smoke regularly before the age of 18, that number doubles, with 18% meeting the criteria for dependence at some point in the lifespan.

Why Many Dispute Marijuana Addiction

When so many people can use marijuana on a recreational basis without ever developing serious problems from their use, how can we call this an addictive drug?

Well, though marijuana is addictive, it’s not very addictive – certainly not as addictive as many other commonly abused drugs. For example, though 9% of marijuana users will develop an addiction at some point, according University of California Professor and Psychologist Jann Gumbiner, Ph.D, 15% of people who use alcohol will become addicted, as will 17% of cocaine users, 23% of heroin users and 32% of cigarette users.⁶

Extrapolating from Personal Experience

If it didn’t happen to you or anyone you know – could it still happen to other people you don’t know?

Almost half of all American adults have tried marijuana at least once (a Michigan State Univeristy study from 2007 puts the number at 43%) so this is well over 100 million Americans. The vast majority of this number never got addicted.

1. If neither you nor any of your friends experienced any marijuana addiction, it becomes easy to discount its existence – but remember, only about 1 in 10 ever develop a serious problem. Are you absolutely sure that for every 10 people you know who smoke or smoked marijuana not one will ever have had or have an addiction problem at some point over an entire lifetime?
2. For most people this is an impossible question to answer. If you’re young and the people you know who use are also young, you can’t yet say whether any will have an addiction over their lifespan. If you are older and smoked a long time ago, then you are unlikely to have stayed in close contact with all the people you smoked with back in your younger years.
   

Due to these longitudinal challenges, we can’t just use personal experiences to extrapolate general information – we have to rely on valid research studies.

Marijuana Addiction Risk Self Test

Are you at risk of marijuana addiction?

To find out, answer the following questions, based on the cannabis abuse screening test.⁷ For each question, give yourself a score from 0 to 4, where:

• 0 = never
• 1 = rarely
• 2 = occasionally
• 3 = often
• 4 = very often

The Questions

Answer each question based on your behaviors over the last year 12 months.

• Have you ever smoked marijuana before noon?
• Have you ever had memory problems when smoking marijuana?
• Have you ever smoked by yourself?
• Have you had any friends or family members express concern about your marijuana use or ask you to cut-down or stop?
• Have you tried to stop using or cut-down without success?
• Have you experienced life-problems related to your marijuana use, such as problems at school or work, problems at home or with important relationships, money problems, legal problems and others?

Scoring

If you score:

• 0 to 2 = You have no addiction risk.
• 3 to 7 = You have some addiction risk.
• 7 or higher = You have a high addiction risk.

If you’re still in doubt, try an easy marijuana addiction self test or teen marijuana addiction self test that may help you better understand your situation. 

If You Decide to Quit or Cut-Down

Many people can overcome marijuana addiction without professional help. For advice on quitting, cutting-down or getting past marijuana withdrawal symptoms, read:

• Marijuana: how to cut-down - For 20 harm reduction strategies on reducing your use when you don’t want to quit entirely.
• Marijuana withdrawal symptoms - To find out what percentage of heavy users experience which withdrawal symptoms.
• Marijuana withdrawal symptoms severity - Will you experience serious or mild withdrawal symptoms? Learn what predicts more serious symptoms.
• Marijuana withdrawal insomnia - Tips and tricks for getting to sleep in the first week after quitting.
• Causes of marijuana relapse - 10 common relapse triggers and how to get past them. 
• Increase your odds of long term marijuana recovery - Learn coping skills that help you stay off marijuana for good.

If you try on your own and you can’t achieve your goals (be they abstinence or moderation) then it makes complete sense to get some professional help, either through a formal marijuana addiction treatment program or by working with an addictions therapist. If a few weeks spent learning of cravings management and relapse prevention strategies can help you get your use under control, then that’s almost surely time well spent.