On my daughter's fourth birthday, a swim party in 2002, my youngest sister showed up late in an outfit befitting a weekend rager: ratty black jeans, a threadbare camisole and a long-sleeved voile blouse in dingy white.
"It's the closest thing I had to a bathing suit," she told me skittishly, before wandering off to smoke a Camel.
Then, she disappeared for two hours. She reappeared only when everyone had left, running to us across a field, so skinny her bones seemed to rattle.
Looking back, her choice of swimwear should have been another of the warning bells going off that year. There were the false teeth she'd gotten to replace her own because of a rare gum disease. The frequent, sudden naps -- in a chair, on my rug. The strange gifts -- used teleconferencing software for me, worn beige tap shoes for my daughter. The way she'd fought me -- bitterly, unrelentingly -- when I'd refused to let her take my bike out late one night for a spin.
Two months after the party, I learned the reason for the get-up and behavior: My sister, then 42, had become addicted to methamphetamine. The shirt and long pants on that hot summer day were to cover the tracks from shooting up. And the lateness? Victim to the compulsive behavior that is one of meth's hallmarks, she'd been sidetracked diving into dumpsters to collect "treasures" on her way to see us.
What had driven this successful juvenile-defense attorney to turn to drugs? As she tells it, a big part was precisely that: the stress of winning cases--of keeping moms from having their parental rights terminated (one client's child died while in foster care). My sister, upended by the child's death, had "burned out."
September is National Alcohol and Drug Addiction Recovery Month, proclaimed as such by President Barack Obama. It's a time for the Substance Abuse and Mental Health Services Administration (SAMHSA), of the U.S. Department of Health and Human Services, to celebrate folks like my sister (she's eight years clean this month!), as well as those who provide recovery services. This year the Recovery Month theme, "Join the Voices for Recovery: Now More Than Ever!," highlights how psychological stress contributes to alcohol and/or drug use, and the disorders or relapse that may follow.
My sister could have been the poster child.
"Stress is not a vague term; it is generally concerned with profound events in a person's life," says H. Westley Clark, M.D., director of SAMHSA's Center for Substance Abuse Treatment, which oversees Recovery Month. He ticks off several common stressors: job loss, death of a loved one, illness, financial worries. Why choose the theme "stress" now? "Given the current state of the economy, this is a particularly stressful time," he says.
How can we know if we might be at risk for alcohol or drug abuse? We can note not only if we're drinking more, but also our reactions to stressors. "Listen to other people," says Clark. "Are they saying you seem angry or irritable, or that your personality has changed--that perhaps you're more explosive or more withdrawn?" Those may be red flags.
Yet the relationship between stress and addiction is deeper than circumstantial; indeed, it runs right down to the cells in our brain.
Since at least the mid-1970s, scientists have been showing, through animal and human studies, that stress hormones--particularly "glucocorticoids" ("cortisol" in humans)--activate the same reward system in the brain as cocaine, heroin, and other drugs of abuse.
True, the degree of activation is different, but the process is the same. Both glucocorticoids and addictive drugs stimulate cells in a part of the brain called the ventral tegmental area (which sits atop the brainstem), to release the neurotransmitter dopamine. The dopamine then zips via nerve fibers over to the nucleus accumbens, a.k.a. the "pleasure center" of the brain. The information, "Ahh, pleasure," is then relayed to the prefrontal cortex, where it makes its way into consciousness.
Mind you, the dopamine itself is not the reward. Rather, it sparks the motivation to do the work to get the reward. The good feelings are ones of delicious anticipation and mastery: "Yes we can!" chanted Obama volunteers, their dopamine flowing, knowing in their hearts that the presidency was within reach. This dopamine-inspired drive exists to keep us alive. When we're hungry or thirsty, it drives us to seek food and water. When it's time to reproduce, it drives us to seek sex. Good job! the reward circuit tells us when we've located the watering hole or a mate, thereby reinforcing the behavior. We beam. Glucocorticoids pump up that drive, making the water appear even more sparkling and the mate even hunkier. They supercharge the wanting.
What we want during stress, scientists say, depends on context. The reward just has to be palatable, a natural reinforcer. Studies have shown that if a rat is stressed and a hunk of pork fat and regular chow are both within reach, it'll make a beeline for the pork fat. If cocaine is available at the push of a lever, it'll go for that. If a running wheel is the only game in town, it'll exercise its little legs off.
"The more glucocorticoids, the more dopamine," says Mary F. Dallman, Ph.D., professor emeritus at UCSF and an expert on stress physiology. "The more the dopamine, the more this pleasure center stuff turns on--the wanting, the salience."
Turning down the volume
Are there skills we can learn to turn down the volume of the wanting?
UCSF psychologist Judith T. Moskowitz, Ph.D., M.P.H., studies ways to "plant seeds of resilience" in people under extreme stress because they've recently been diagnosed with a chronic illness, in particular HIV. She knows, through years of research, that positive and negative emotions "co-occur" under conditions of stress but that people need help countering the negative and allowing the positive to rise through the muck. After scouring the scientific literature, she identified specific cognitive skills that are especially effective at helping people achieve this.
"Find at least one of these that works for you, and do it every day," she advises.
• Notice something good that happened to you today, and tell someone about it or write it down. The "event" can be as small as drinking an excellent cup of coffee or climbing out of bed when you planned to.
• Keep a "gratitude" record. Every day, to counter shortfalls, write down one thing you're grateful for. Again, it doesn't have to be earth shattering, or even big.
• Concentrate on being mindful for at least 10 minutes a day. Forget the past, forget the future: Take in, without judgment, your thoughts, feelings and physical sensations right now. For example, go for a 10-minute walk and zero in on the crunch of gravel beneath your feet and the wind on your face.
• Reinterpret a negative experience. The reinterpretation must be "do-able," says Moskowitz. You miss the bus to work and know your boss will be furious that you're late. But then another bus arrives, and you sit next to someone who tells a joke that sends you into hysterics. In a meta-analysis of studies about coping with HIV, Moskowitz found that reappraisal was one of the skills most effective at reducing negativity.
• Redirect your attention to your strengths.
• Make a list of attainable goals for the week, and work toward achieving one every day. Think how good you'll feel when you can cross that item off that list!
• Do something nice for someone else. The University of British Columbia's Elizabeth W. Dunn, Ph.D., has done several studies showing that giving can make people happier. In one, she had 46 UBC students rate their happiness, and then gave them envelopes containing $5 or $20 and told them either to spend the money on themselves or toward a bill, or to give it to charity or as a gift. Those who gave the money away rated themselves as happier at the end of the day than those who kept it for themselves.
Thea Singer is a science/health journalist. Her new book, "Stress Less," which comes out September 23, covers the latest findings on stress and how to reduce it to slow--or even reverse--aging. Her sister is a policy analyst for the National Council for Alcoholism and Drug Dependence--New Jersey and tells her story nationally to help others find recovery. Learn more at www.theasinger.com.
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