Love Addiction

Love Addiction

The concept of love addiction comes out of the addictions treatment community, thus the name addiction and there’s this understanding or it was previously thought that love addiction was rooted in what would be called an addiction process or a process addiction. Therefore, the treatment, the thinking, the approach to working with love addiction was similar to working with other addictions.

Attachment styles, or a system that’s built into our brain and is connected to our nervous system and this attachment system being how we bond and connect with people, which in turn comes from our family, from our parents. Another phrase used is called primary caregivers. So, if we had a close person that was our significant caregiver, we developed an attachment style that really allows us to use that template in our mind for how we create and recreate adult relationships in our life.

Now there’s a challenge to this attachment system if there were insecure attachments within your family or with the primary caregiver, often times if we have some kind of history of being abandoned or neglected or ignored and for some people that also includes being abused. Regardless of where you fall in that spectrum when there is an insecure attachment, we seem to bring that into our adult lives and we then create an insecure attached relationship. This is not conscious, it has to do with the part of the brain called the limbic brain and the limbic brain is not the thinking brain or the conscious brain. It’s the part of the brain that operates from a very primal, emotional place that experiences trust and safety and knows how to interact and relate with another person.

If the limbic brain gets triggered or activated in such a way out of an emergency, a sense of separation, feeling like the relationship is not full of trust and safety, what’s going to release are a number of hormones. Hormones will get released into your body, certain chemical processes, and it’s going to activate anxiety. And how we manage this anxiety really determines or will evidence the number of symptoms that we call love addiction. So, what love addiction is all about is developmental, emotional trauma that is rooted in attachment injuries. That’s a little bit of a different focus than channeling our thinking through an addiction lens or an addictions model for how we would work with these symptoms and characteristics referred to as love addiction.

To seek out a relationship with another person is to say will you show up, will you listen, will you bring a level of responsibility, a level of seriousness to this conversatio, to be able to witness the part of the me that I need to share; part of my humanity. A way to capture the importance of relationships and a reason why love addiction begins in the first place, is due to our personal history. For love addicts that were not seen, known, heard or understood. When they are seen, known, heard and understood, there’s an exchange. There’s this emotional attunement, there’s an emotional connection that’s made between two people and our bodies are nervous system functioning in our brain actually activates and we sync up with another person and this allows us to calm down and to feel a sense of peace. Life will have a sense of possibility when we derive strength and support from other people.

This is what we all want deep down on a very fundamental basis, we want to experience that level of connection, of being seen, known, heard and understood. When a person is struggling with an attachment injury and you have a lot of anxiety or you have the symptoms showing up that get referred to as ‘love addiction’, it’s impossible to think yourself out of the activation of that anxiety. The reason is there are different parts of the brain that are working when this emotional trauma is activated or triggered. It’s not thinking based, you’re not just going to be able to think yourself out of it. For that reason, phrases like, ‘just let it go, just get over it, calm down’, etc. are essentially unhelpful because they appeal to reason & not emotion.

Oceanside Malibu Addiction Treatment

Resentment: The Main Offender

Resentment in Recovery

Resentment is the number one offender on the road to relapse in addiction recovery. When we really can hold on and really feel the pain that we’ve had, in some cases for a very long time, where maybe we feel we’ve been wrongly done or we’ve been hurt where perhaps we shouldn’t have been…it can really take grip and keep us wrapped up in addiction. Resentment serves to help us re-feel old pain and we kind of torture ourselves with it by re-feeling it and hitting the replay button many times. Doing so actually turns into self-resentment, loathing and self-pity, we can take ourselves out of the equation feeling that we have no part in that resentment. Probably we did and it normally works out that we had a lot more part than we believe and it wasn’t all on the other person, place or thing.

It is important to work on your resentments in rehab, in recovery and throughout life in order to stay sober. Many people struggle with resentments towards family members and that can be really difficult, it’s an ongoing thing, a work in progress. We have to change our actions, really recognize our part and learn to show compassion towards people who are imperfect. People tend to deal with what’s been passed down to them and so much resentment is just passed-on pain patterns with which we need to break free. When we can have compassion, that people are just human, people make mistakes, we can break free from resentment, we can give ourselves a good chance to not keep hurting.

If we believe its important just to find some peace in life, especially in recovery, then its best not to keep re-living our grudges. The more we disengage or isolate and cut people off when actually we crave connection. The deeper into a resentful attitude we may descend, the closer to relapse.  It’s through connection, it’s through belonging that we are going to succeed in recovery. Often what we see with resentment is that we’ve actually engaged in the same behaviors that we are angry about, what we feel has been done to, then we’ve gone on to do the same things to others. So can we really be so blameful towards those people when we’ve done just the same to them or others?

Can we see that perhaps we’ve wronged people in similar ways and it was all because of our addictions turning us into somebody we never wanted to be? Things we never really wanted to do, we ended up doing because of the grip of addiction. We can break free from that and change behaviors, actions we take today so that resentment doesn’t keep us returning to active addiction. In recovery, its important that we highlight this issue and do the work that we need to. There’s work to be done and this work can never be done alone, we’ll never get out of resentment on our own. Our own head makes it real, it makes it true, but when we share what we are feeling to another human being in an honest attempt to rid ourselves of resentments we can get another perspective. This may help us see things clearer and find freedom.

Oceanside Malibu

Resilience & Action Lead To Long-Term Recovery

Resilience in Recovery

Resilience is a psychological skill, it’s actually a life skill. It’s not a trait, it’s a combination of thoughts, behaviors and actions and it’s going to help you to deal with stress and emotional pain. Have you ever wondered why some people are really good at dealing with stress, trauma, crisis?  Why some people are better than others at adapting to adversity? The good news is that resilience can be learned. You can learn how to see and think about events in a different way, you can self-regulate your emotions, and then become more resilient.

Accept that change is inevitable. The serenity prayer, ‘God grant me the serenity to accept things that we cannot change’, is not just words. Acceptance is the most difficult step, but it’s the first step. Even though you have goals and expectations, and even if you take the right decisions, things might not turn out well. You might realize that some situations and some people, you cannot control.  You can control what you think and you can work with your rigid thinking, with your ‘shoulds’:  Life should be fair, people shouldn’t be doing that.  Loosen up your black and white, rigid thinking pattern. You can become more flexible and accept reality, so you will have realistic expectations of life.

Change is inevitable, but growth is optional. It’s up to you if you want to see obstacles or challenges, if you see mistakes as failures or learning opportunities and opportunities to grow. The same goes for learning from the past. Look who you have become. You are most likely stronger than you think. Look where you come from and look where you are now. How did you survive? What did you learn from yourself? What did you learn about how to relate with other people? What kept you going and what kept you hopeful? If you choose to use your experience as fuel to move forward, you will be happier and even be able to help people in recovery as well. It is possible.

Whether you’re a religious person, or spiritual, or the logical type, things will get better if you think they will get better. Start with small steps, be thankful for what you have, the people you have around you. Find gratitude for small things in your life. It could be very simple, like you wake up sober and you go to bed sober.  Train your brain and your soul to see the positives of life. Appreciate the people that you have around you, family, friends, but also those in your recovery community, like NA, AA, SMART Recovery, Radical Recovery, etc.

The opposite of addiction is connection, so make new connections. Volunteer groups, people with the same hobbies as you. Action is as important as resilience. You don’t need to see the whole staircase, just take the first step. And yes, stepping out of your comfort zone is scary, but it’s going to give you a feeling of accomplishment and empowerment. You’re going to have a boost of confidence, and that’s going to help you, and that’s going to have a huge impact on your recovery. So start with small steps, realistic expectation. You can start something daily, whether it’s going to the gym, practising your non-volitle communication skills. Start small and keep practicing, because practice will make routine and routine will become automatic habit.

Finally, take care of yourself.  Especially in early recovery, self-discovery is going to be a big challenge. You lost yourself in addiction. You might not know who you are any more, you need to find what your needs are now. So be gentle to yourself, identify your emotions, listen to your body. Sometimes it could be with meditation, mindfulness, tapping. It could be easy and simple, like placing your hand on your heart. Connect to yourself. Resilience is about becoming more flexible with your mind, learning to rely on others. Some optimism is necessary, a realistic expectation of life, and get to be more confident with your strengths and your abilities. Remember action is more important than intention and be gentle to yourself.

Oceanside Malibu

Starting New Relationships While In Treatment

Relationships in Treatment

Coming into a treatment center means you’ve identified that you want help, which is great. It may be the bravest thing you’ll ever do. Generally, when someone comes into treatment, they are coming because there are pieces of their lives that may be missing, maybe they can’t deal with life on life’s terms and are struggling with day-to-day existence.  People come into treatment normally as vulnerable adults & with that comes emotions that may not have been expressed for some time. Feelings that perhaps someone doesn’t even know how to express.  It can be a very emotional and confusing time.

While in the confusion of ‘what is my life going to be like, what am I going to do?’ all the thoughts, reasonings, fears that you’d go through while in treatment, normally what we would do with that, is we would use drugs. We would do something to suppress those feelings because that is our coping mechanism, that’s what we do to cope with life, that’s what you do to cope with feeling out of control. So it’s very common for men and women to start looking for other things, external of themselves, to fix that feeling. In treatment you generally don’t have access to drugs and alcohol so therefore it’s very common for you to start fixing on people.

Romantic relationships blossom in treatment quite regularly simply because people generally don’t have access to habitual ways of suppressing feelings. Yet conversely, romantic relationships also stir up both new & old feelings and this is highly dangerous for the individual in treatment who is not yet adequately equipped to handle their own emotions. Treatment, early recovery is a chance for you as an individual, to grow, to learn, to process and to get out any of that stuff that you’ve been carrying around, probably for many years and which has helped fuel addiction. This is an opportunity for you to learn and grow. Perhaps this time should be used most wisely.

Relationships can actually light up the same parts of the brain as when you are using drugs or alcohol, some of the same receptors, it’s the same reward centers in the brain. In effect, you are fixing your feelings so therefore you are still using in a sense, but through people instead of substances. The chances of relapse can be much higher once getting into a relationship while in treatment or early recovery simply because of the chemical reward. You may not be focusing as much on treatment, not on the real reasons you have come to treatment. One may actually start to focus on another person because they are fixing those feelings, so they become the new drug.

Staying out of relationships in early recovery, while a seemingly trivial guideline, is really important. Say the other person was to relapse, or this other person was to abscond from treatment, how would you feel then? How would you be left, in even more pain (?) which you’d want to suppress even more…but now you have nothing else to suppress those feelings with. With emotions now heightened, you may also abscond from rehab to join your new partner. One’s ability to make good, sound choices is compromised once in a romantic relationship because the focus is lost.

Recovery is about self-discovery, an amazing new journey if you can keep the focus on yourself. This is why it’s been recommended in some recovery circles not to get into a relationship for the first year. There may be a good reason for that, you’re going to learn skills, you’re going to learn tools, you’re going to learn how to self-regulate emotions and feelings. You’ll be going to meetings, making new connections, you’re going to start to develop new social skills. If you don’t know how to practice all that already and you’re not giving yourself a chance in the beginning of your recovery, then what chance will you have later on? The relationship is only a deterrent from what the problem actually is and that lies within.

Relationships in treatment or early recovery can also be an avoidance of self. Some people like to take care of other people in order to avoid what’s actually going on with them. It’s like, ‘if I just look after this person over here then I don’t have to actually look at what I’m feeling and acknowledge how scary it is to feel feelings.’ It is important to feel & acknowledge how scary it is to express feelings, all the fears that surround feeling and emotions. However, its highly important one learns to do that early on in order to have a successful recovery and therefore not avoid things. You come first in your recovery. Take care not to use other people’s vulnerabilities to fix your feelings and don’t allow somebody else to fix off your vulnerability either. Remember you are in treatment for you. You have to put yourself first, probably for the first time in a long time.

Oceanside Malibu Addiction Treatment

Opioid Use Disorder

Malibu Opioid Addction Treatment

Worldwide, the abuse of opioids and resulting Opiod Use Disorder, are the most common cause of drug related deaths. The number of individuals abusing these drugs has quadrupled in the last 20 years, with an uptick in heroin use, an even bigger uptick in prescription opioid use, and a large group of folks abusing both. Because of their potential for addiction and overdose, opioids are regulated substances in a lot of countries. As a class, opioids share one thing in common — they bind to opioid receptors in the brain, spinal cord, and gastrointestinal tract.

Some opiods are known as endogenous, meaning that they are produced naturally by the body, like endorphin, short for endogenous morphine. But others are exogenous, meaning that they come from the environment, like heroin and morphine because they come from the opium poppy — a flowering plant that oozes out a milky white liquid, while others like fentanyl are synthesized in the laboratory. To understand how opioids work, its necessary to focus on a region of the brain tissue that has opioid receptors.  Normally, in the absence of endorphins, inhibitory neurons secrete a neurotransmitter that prevents nearby neurons from releasing the neurotransmitter dopamine.

Say a person goes to play a rigorous game of tennis.  Exercise releases endorphins which activate the three major opioid receptors located on the inhibitory neurons, called the mu, kappa, and delta receptors.  As endorphins binds to these receptors, they block the inhibitory neurons from releasing neurotransmitters, allowing the dopamine secreting neurons to freely unload dopamine. The dopamine then gets picked up by a third neuron in the same area. When dopamine release takes place in pain processing regions of the brain like the thalamus, brainstem, and spinal cord, the result is feeling less pain. When dopamine release takes place in reward pathway regions like the ventral tegmentalarea, nucleus accumbens and prefrontal cortex, the result is a calming effect that feels good.

That’s how things would normally work, but when a powerful exogenous opioid binds to the opioid receptors, the result is a massive flood of dopamine. This helps with pain control, but it can also cause an incredible state of euphoria within the regions of the brain involved in the reward pathway, which is an emotional “high”.  Now remember, the purpose of the reward pathway is to train the brain to repeat activities that cause dopamine-mediated pleasure, so when opioids stimulate this reward pathway, the brain learns to do that behavior again and again.

In the case of exogenous opioids there are multiple routes to get the drug to the brain. One way is by ingesting it, but that route is the slowest.  A faster route would be inhalation, because the drug is rapidly absorbed through the lungs. The fastest route, though, is direct injection of the substance into the blood.  Typically, the faster the exogenous opioid reaches the brain the stronger the relationship between the behavior and the reward.  Now over time, people that are consistently using a drug, even when taking them exactly as prescribed, can develop tolerance which means that with repeated use, they have a reduced response, and therefore an increased dose is needed to achieve the original response.

At a cellular level, there are two theories that explain why this might happen.  One theory is that opioid receptors might become less sensitive to a drug, and the othertheory is that the neurons may remove opioid receptors from the cell wall in a process called down-regulation, leaving less receptors available for binding.  In either scenario, tolerance leads to the need for higher and higher doses of a drug, and often times that tolerance remains for a long time even after tapering from the drug.

When you are at rest, there aren’t any drugs or anything stimulating your reward pathway.  In this situation, your brain keeps your heart rate, blood pressure, and wakefulness in a normal state, called homeostasis.  Now, let’s say that you get a text message, call or something indicating that there’s some sort of ’emergency’.  All of a sudden you may feel sweaty and flushed, your heart rate may jump a bit. You’re now above your normal level of homeostasis, because something has changed, right?  But it doesn’t stay that way for long after the next text message or phone call reveals it to be a false emergency; your brain brings things back down to this baseline.

Perhaps you were to take the drug at a specific time and setting, like 3pm in the bedroom, and, being a depressant, it makes everything go lower, heart rate, blood pressure, and wakefulness. Your brain being the smart brain that it is, will pick up on the pattern. Now, next time, at 3pm in the bedroom, the brain preemptively increases each one, since it knows that when you take the drug, everything’s going to decrease again. Now, let’s say 3pm in the bedroom rolls around, but there’s no drug.  In that situation, the brain still increases everything but the changes aren’t countered with the effects of the drug, and so the person can feel awful, and these are called withdrawal symptoms.

Withdrawal symptoms can persist to the point where a person may need drugs just to feel normal,and if that’s the case, they are considered to be dependent on that drug. Now, on the flip side, let’s say that you use the drug in an unfamiliar setting, like at 11pm at a party.  Well in that situation, your body’s not ready for the drug and there’s no physiologic counter-balance to help offset the effect of the drug. When that’s the case, it can lead to overdose, even on a dose that the person’s been normally taking, and that’s often times what happens. The symptoms of opioid withdrawal include anxiety, shivering, tremors, yawning, bodyaches, vomiting, diarrhea, abdominal cramps, runny nose, sneezing, sweating, and an increased heart rate and blood pressure.

These symptoms can feel really awful, and often prompts people to use opioids again;a process called negative reinforcement, since you’re removing the drug, which causes withdrawal symptoms which reinforces more drug use to avoid those symptoms. There is also positive reinforcement from the dopamine-induced euphoria, again leading to more drug use. Together this positive and negative reinforcement leads to opioid addiction also known as Opioid Use Disorder.

Opioid Use Disorder reveals itself in at least two of the following behavior patterns within a year according to the DSM-5:

  • Using more opioids or using them for longer than intended
  •  Being unable to cut down on the use of opioids
  • Having opioid use take up a significant amount of time
  • Having cravings to use opioids
  • Having opioid use affect responsibilities at work, school, or home
  • Using opioids even if they cause recurrent interpersonal problems
  • Giving up important activities in order to use opioids
  • Using opioids in physically dangerous situations
  • Using opioids while worsening a physical or psychological problem
  • Becoming tolerant to the opioids
  • Feeling withdrawal symptoms from opioids

Having 2 or 3 of these symptoms is considered mild, having 4 or 5 is considered moderate, and having 6 or more is considered severe. In addition to ruining a person’s life, opioid addiction can also end it in an overdose.

Most often, an opioid overdose causes severe cardiac and respiratory depression, to the point where a person may have pinpoint pupils and simply stop breathing. In that situation, the most important thing is to perform rescue breathing, giving supplemental oxygen, and administering naloxone.  Naloxone is an opioid antagonist that powerfully binds to opioid receptors, and rather than having a direct effect, it blocks other opioids from binding and activating the receptor. This works because at any given moment, opioids are binding and unbinding to receptors which means once an opioid releases its hold on a receptor, the naloxone can simply sneak in and bind more strongly.

When naloxone given intravenously it can reverse the effects of opioids within minutes, potentially saving a person’s life. Generally speaking, high doses of strong opioids carry the greatest risk of addiction and death, and when paired with other substances that can cause respiratory depression, like benzodiazepines, they’re more likely to cause overdose.  This is because they can act synergistically to cause respiratory depression.

For people with opioid dependence, the most effective treatment is a combination of therapy with medications. Specific therapies that work include motivational interviewing, which can be used to understand why an individual wants to stop using opioids and identify specific barriers to treatment. Also cognitive-behavioral therapy can help an individual learn about withdrawal, discuss the thoughts, feelings, and behaviors that lead to opioid usage, and create a plan to navigate triggers for usage. Another form of therapy are peer-support programs which use group discussions to help individuals commit to ending the use of opioids and by holding one another accountable.

In addition, the use of medications, which reliably decrease cravings and reduce withdrawal symptoms.  Methadone is a full opioid agonist with a long half-life that slowly builds up in the tissues over time, allowing it to reach a steady-state level within a week. Steady-state refers to the situation where the overall intake of the drug is more orless in balance with its elimination, so that the body is exposed to a stable level. In contrast, buprenorphine is a partial agonist that is sometimes given in combination with naloxone, forming an agonist/antagonist combination. Buprenorphine has a ceiling effect, meaning that above a certain dose it does not have any more of an effect, which reduces the chance of an overdose.  Another medication called naltrexone, can be used for people who are already abstaining from active opioid use. Naltrexone is a mu-opioid receptor antagonist that blocks the effects of opioids and helps maintain abstinence.

These medications can competitively bind to the opioid receptor without producing the same euphoria as the opioids they take the place of.  Since they have opioid effects, though, they can cause side effects like constipation, insomnia, weight gain, hormonal changes, and cardiac arrhythmias. The good news is that over time, an individual can safely taper their use of opioid treatments altogether.  This approach is more likely to succeed than simply stopping opioids withoutt hese treatments.

Finally, all of these approaches work best when an individual has a strong network offamily and friends offering support. Opioid use still carries heavy stigma because usage is still tied to a notion of individual choice and moral failure, even though we now know that opioid use is a consequence of biological, psychological, and social factors — all of which need to be addressed to maximize the chances of recovery. The most effective treatment is a combination of therapy and medications, with a lot of love and support from family and friends.

Contact Oceanside Malibu Addiction Treatment Center

Buprenorphine or Methadone?

Malibu buprenorphine Treatment

It’s always a question whether methadone or buprenorphine might be the right medication for any patient.  When talking about methadone we’re really talking about a whole sort of treatment structure or program.  Essentially with methadone treatment, there’s built in counseling, which is very important as part of the recovery process. There’s urine drug testing which you might think, ‘well, why would I want urine drug testing?’  Many people actually find it a real support in working on their recovery. There’s also more services available in a methadone program.

In regards to buprenorphine, treatment happens largely in integrated medical settings. So it might happen with your primary care doctor, it might happen with your psychiatrist. It’s very convenient and you also have the simplicity of receiving a prescription for your medication and going to the pharmacy.

If you have a chronic pain problem where you’re needing to take opiate pain medications, then generally speaking buprenorphine is less of a good choice for you because it is very strong in terms of blocking the affects of opiates and it can be difficult to do a good job of treating pain with opiates on top of it. Methadone is going to make you have less problems with pain management, so that’s a big consideration also.

Also keep in mind that if a choice is made to treat with buprenorphine and for whatever reason that that’s not working well, you can make a switch and try treatment with methadone. One can go the other way as well. If you’re in methadone treatment and it’s decided at a certain point to switch to buprenorphine treatment, then that’s possible also.

Oceanside Malibu Addiction Treatment Center