Scientific Findings and Achievements in Drug Abuse Research for 2018

From the Blog of Dr. Nora Volkow, Director
National Institute on Drug Abuse
January 7, 2019

Dr. Volkow noted, “As we enter 2019, it is a good time to take stock of what NIDA accomplished over the past year. As always when I look back at the research being done by NIDA grantees and partners, I am amazed at the wealth of knowledge being created from our investments. Here I want to highlight just a few of the many outstanding developments in basic science, new therapeutics, and epidemiology and prevention research from the year that just ended.”

Basic Science Advances

Recent years have seen major advances in the understanding of receptor functioning. In March 2018, a team of researchers at NIDA’s Intramural Research Program (IRP) reported in Nature Communications on an advance in understanding G protein-coupled receptors (GCPRs), a large family of receptors that play an important role in the brain’s response to drugs. These receptors often assemble into larger complexes, but it has been unknown whether those complexes are merely the product of random collision between signaling molecules as they move across the membrane or whether they pre-form into complexes that serve specific functions.

The IRP team found that two common GCPRs in the reward pathway, adenosine A2A and dopamine D2 receptors (along with their G proteins and target enzyme), assemble into preformed macromolecular complexes that act as computation devices processing incoming information and enabling the cell to change its function based on that information. This knowledge could facilitate the development of more precise medication targets.

In June 2018, a team of NIDA-funded researchers at the University of California–San Francisco, along with colleagues in Belgium and Canada, reported in Neuron magazine that they had developed a genetically-encoded biosensor that can detect activation of opioid receptors and map the differences in activation within living cells produced by different opioids. The fact that opioids bind to receptors on structures within the cell—and not just on the cell membrane—was itself a novel finding, but the team also discovered striking differences in how endogenous versus synthetic opioids interact with these structures.

While endogenous peptides activated receptors on membrane-bound compartments within the cell called endosomes, synthetic opioid drugs activated receptor sites on a separate structure called the Golgi apparatus (which acts as a hub for routing proteins to various destinations in the cell). These very different patterns of activation within the cell may lead to greater understanding of why non-peptide opioid drugs produce tolerance as well as the behavioral distortions seen with opioid misuse and addiction whereas the body’s endogenous opioid peptides do not.

The same month, a team led by neuroscientists at UCLA studying narcolepsy reported research in Science Translational Medicine based on their discovery that postmortem brains from individuals who had been addicted to heroin show greatly increased numbers of neurons producing the neuropeptide hypocretin. Hypocretin helps regulate wakefulness and appetite, and a diminished number of cells in the brain producing it is associated with narcolepsy. The researchers went on to conduct a study administering morphine to mice, which as observed in the postmortem study produced increased numbers of hypocretin neurons. The results suggest that increases in these cells and in brain hypocretin could underlie the complaints of sleep problems in patients with an opioid use disorder (OUD). Since insomnia is a factor that contributes to drug taking in OUD and other addictions, strategies to counteract hypocretin signaling might have therapeutic benefits.

Prevention and Treatment

Last year, NIDA-funded research resulted in new therapeutics and apps for opioid use disorder. In May, the FDA approved lofexidine, the first medication approved to treat physical symptoms of opioid withdrawal. In December, the FDA cleared the first mobile health app intended to help retain patients with OUD in treatment, called reSET-O. It uses interactive lessons to deliver a community reinforcement approach therapy and enables users to report cravings and triggers to their health care provider between office visits, along with whether or not they have used Suboxone. NIDA funded the clinical trial that led to this app’s approval. A version called reSET was approved in 2017 to help with behavioral treatment of several non-opioid substance use disorders.

NIDA-funded research in epidemiology and prevention also added greatly to the knowledge of new drug trends in 2018. Last month’s striking findings on monitoringthefuture.org alerted us to escalating use of vaping devices among adolescents. Although most adolescents in 2017 claimed they used vaping devices only to vape flavors, this year most reported they used them to vape nicotine. Alarmingly, there was also an increase in vaping of cannabis.

Several other studies published in 2018 increased our understanding of factors that may lead youth to experiment with vaping. For example, a longitudinal cohort study by researchers at Yale and reported in Addictive Behavior found that exposure to ads for e-cigarettes on social media sites like Facebook significantly increased the likelihood of subsequent e-cigarette use among middle and high school students in Connecticut. In another study published in Preventive Medicine, the researchers also found that higher socioeconomic status was associated with greater exposure to e-cigarette advertising (which in turn was associated with increased likelihood of use)—important data that can help with targeting prevention efforts. Other work by UCSF researchers and published in Pediatrics found that e-cigarette use in adolescents was positively associated with being a smoker of conventional cigarettes, lending further support to the view that these devices are not diverting youth from smoking cigarettes but may be having the opposite effect in some users.

Looking To The Future

This year the Adolescent Brain Cognitive Development (ABCD) Study successfully completed recruitment of 11,874 participants, ages 9-10, who will be followed for 10 years, through young adulthood. The study, which is being conducted at 21 research sites around the country, is using neuroimaging to assess each individual’s brain development while also tracking cognitive, behavioral, social, and environmental factors (including exposure to social media) that may affect brain development and other health outcomes. The first release of anonymized data was made available so that both ABCD and non-ABCD researchers can take advantage of this rich source of information to help answer novel questions and pursue their own research interests.  Last year alone, the data resulted in more than 20 publications.

 

Dope Slinger

I was twelve when I first met him
As he sat in his Ford Gran Torino,
Canary yellow to be specific,
A Glock 40 on his lap.
He was calm, almost polite,
With a wry smile. I couldn’t
Help but be distracted by the
Long, ugly scar on his left cheek,
Extending nearly to his Adam’s apple.
I was too scared to ask him what happened.
He said, “Whachu want?”
I told him, “You know. Chiva.”
How much, little man?”
I realized for a hot second that he
Didn’t care I was only 12.
Why would that matter to a dope slinger?

©2016 Steven Barto

Me Included

I recently took the time to read President Obama’s report Epidemic: Responding to America’s Prescription Drug Abuse Crisis (2011), published on the monthly blog of Dr. Nora Volkow, director of the National Institute on Drug Abuse. (Sept. 14, 2016) According to the president’s report, prescription drug abuse is the nation’s fastest-growing drug problem. While there has been a marked decrease in the use of such illegal drugs as cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and older who used drugs for the first time in 2009 began by using a prescription drug non-medically. The survey found that over 70 percent of people who abused prescription pain relievers got them from friends or relatives, me included.

I started taking opioid pain medication for severe low back pain in 2004. The pain became debilitating, and I was approved for Social Security Disability Income in 2009. Being an addict and an alcoholic, I should have realized that one pill was too many and a hundred was not enough. At one point, I was seeing three different doctors and going to several different pharmacies in order to avoid suspicion. I could not keep up with my cravings. When I could no longer get enough pain meds through doctors and  ERs, I started stealing medication from everyone in my family. I realized just the other day that I have been taking medication from loved ones since 1984 when I started helping myself to my mother-in-law’s Tylenol with Codeine. Although there have been periods where I was able to stop taking opiates, it started all over again about a year before my father died. Following a family intervention, I went to a rehab center for 21 days. I relapsed ten months after I left the rehab. I managed to get clean again until August 20 of this year when I stole oxycodone tablets from my mother. It appears I may have done irreparable damage to my relationship with her. Ironically, that was my greatest fear.

Although a number of classes of prescription drugs are currently being abused, the president’s 2011 action plan primarily focuses on the growing and often deadly problem of prescription opioid abuse. The number of prescriptions filled for opioid pain relievers (some of the most powerful medications available) has increased dramatically in recent years. From 1997 to 2007, the milligram-per-person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, which amounts to 402 percent. In 2000, retail pharmacies dispensed 174 million prescriptions for opioids. By 2009, 257 million prescriptions were dispensed, which is an increase of 48 percent. Opiate overdoses, once almost always due to heroin use, are now increasingly due to the abuse of prescription painkillers.

A crucial first step in tackling the problem of prescription drug abuse is to raise awareness through the education of parents, youth, patients, and healthcare providers. Although there have been great strides in raising awareness about the dangers of using illegal drugs, many people are still not aware that the misuse or abuse of prescription drugs can be as dangerous as the use of illegal drugs, leading to addiction and even death. In addition, prescribers and dispensers, including physicians, dentists, and pharmacists, all have a role to play in reducing prescription drug misuse and abuse. Most receive little training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion, and addiction.

Outside of specialty addiction treatment programs, most healthcare providers receive minimal training in how to recognize substance abuse in their patients. Most medical, dental, pharmacy, and other health professional schools do not provide in-depth training on substance abuse; often, substance abuse education is limited to classroom or clinical electives. Moreover, students in these schools only receive limited training on treating pain. A national survey of medical residency programs in 2000 found that, of the programs studied, only 56 percent required substance use disorder training, and the number of curricular hours in the required programs varied between 3 to 12 hours. A 2008 follow-up survey found that some progress has been made to improve medical school, residency, and post-residency substance abuse education; however, efforts have not been uniformly applied in all residency programs or medical schools.

Educating prescribers on substance abuse is critically important, because even brief interventions by primary care providers have proven effective in reducing or eliminating substance abuse in people who abuse drugs but are not yet addicted to them. In addition, educating healthcare providers about prescription drug abuse will promote awareness of this growing problem among prescribers, so they will not over-prescribe the medication necessary to treat minor conditions. This, in turn, will reduce the amount of unused medication sitting in medicine cabinets in homes across the country.

The president’s report indicates that all of this will take tracking and monitoring. Forty-three states have authorized prescription drug monitoring programs (PDMPs). PDMPs aim to detect and prevent the diversion and abuse of prescription drugs at the retail level, where no other automated information collection system exists, and to allow for the collection and analysis of prescription data more efficiently than states without such a program can accomplish. However, only 35 states have operational PDMPs. These programs are established by state legislation, and are paid for by a combination of state and Federal funds. PDMPs track controlled substances prescribed by authorized practitioners and dispensed by pharmacies. PDMPs can and should serve a multitude of functions, including assisting in patient care, providing early warning of drug abuse epidemics (especially when combined with other data), evaluating interventions, and investigating drug diversion and insurance fraud.

In summary, the president’s report states that research and medicine have provided a vast array of medications to cure disease, ease suffering and pain, improve the quality of life, and save lives. This is no more evident than in the field of pain management. As with many new scientific discoveries and new uses for existing compounds, the potential for diversion, abuse, morbidity, and mortality are significant. Prescription drug misuse and abuse is a major public health and public safety crisis. As a nation, we must take urgent action to ensure the appropriate balance between the benefits these medications offer in improving lives and the risks they pose. No one agency, system, or profession is solely responsible for this undertaking. We must address this issue as partners in public health and public safety. Therefore, ONDCP will convene a Federal Council on Prescription Drug Abuse, comprised of Federal agencies, to coordinate implementation of this prescription drug abuse prevention plan and will engage private parties as necessary to reach the goals established by the plan.

Life Skills Training Shields Teens From Prescription Opioid Misuse

NIDA Notes, December 3, 2015, By Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer, National Institute on Drug Abuse

The Life Skills Training (LST) prevention intervention, delivered in 7th grade classrooms, helps children avoid misusing prescription opioids throughout their teen years, NIDA-supported researchers report. Coupling LST with the Strengthening Families Program: for Parents and Youth 10–14 (SFP) enhances this protection. Dr. D. Max Crowley from Duke University, with colleagues from Pennsylvania State University, evaluated the impacts of LST and two other school-based interventions, All Stars (AS) and Project Alert (PA), on teens’ prescription opioid misuse. The researchers drew the data for the evaluation from a recent trial of the PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) prevention program. PROSPER is led jointly by Richard Spoth at Iowa State University and Mark Greenberg at Penn State University, with research funding from NIDA.

The new evaluation also disclosed that communities that implemented LST in the PROSPER trial more than recouped its cost in reduced health, social, and other expenditures related to teen prescription opioid misuse. The researchers recommend that communities consider implementing LST plus SFP to help control the ongoing epidemic of youth prescription opioid misuse. LST was the only intervention of the three tested that was effective by itself, and it was most effective when the interventions were combined with SFP.

Lessons That Stick

In the PROSPER trial, 14 communities in Iowa and Pennsylvania each selected the intervention they felt best fit their resources and their youth’ risk profile for drug use and other unhealthy and delinquent behaviors. The interventions are all “universal,” meaning that they are delivered to all children, not just those who are judged to have elevated risk for problems.

All the interventions involve multiple sessions of classroom instruction addressing the social and psychological factors that lead to experimentation with drugs and other undesirable behaviors. In addition, through games, discussion, role-playing, and other exercises, students practice refusing drugs, communicating with peers and adults, making choices in problem situations, and confronting peer pressure. The programs’ curricula focus on helping students to develop practical skills they can apply to resist drug use. Materials such as worksheets, online content, posters, and videos augment all three programs.

Each intervention was delivered to all 7th graders in the schools of the PROSPER communities that selected it. Most of the children and their families also received the SFP program during the prior year, when the children were in 6th grade. In SFP, families gather together to watch videos providing advice and instruction toward enhancing family relationships and communication, fostering parenting skills, improving academic performance, and preventing risky behaviors. Group leaders then conduct follow-up lessons and practice exercises.

Dr. Crowley and colleagues previously reported that smaller percentages of children from the 14 PROSPER communities reported illicit drug use and problematic alcohol use in annual follow-up visits conducted through 11th grade, compared to children from 14 matched control communities that did not use any evidence-based prevention program. As well, fewer PROSPER children reported marijuana use in 12th grade.

Win-Win

Dr. Crowley and colleagues determined that LST’s impact on teens’ prescription opioid misuse made it a good financial, as well as health, investment for PROSPER communities. They reached this conclusion by:

  • Estimating the cost to prevent each case of prescription opioid misuse (by dividing the total cost of LST materials, training, etc., by the number of cases prevented).
  • Comparing that number to $7,500, which they estimated, based on previously established figures, is the average expenditure incurred by communities for each single case of teen prescription opioid misuse.

These calculations indicated that PROSPER communities that implemented LST laid out $613 and saved $6,887 for each child that the program prevented from misusing prescription opioids. The corresponding estimates for LST plus SFP indicated expenditures of $3,959 and savings of $3,541 per case averted. Even though communities saved less per benefited child with LST alone, the researchers note, their health benefits were greater and their total savings may have been greater with LST plus SFP, because more cases were prevented.

Dr. Crowley says, “This work illustrates that not only can existing universal prevention programs effectively prevent prescription drug misuse, they can also do so in a cost-effective manner. Our research demonstrates the unique opportunities to combine prevention across school and family settings to augment the larger prevention impact.”

Why Do Addicts Take a Drug That No Longer Gives Pleasure?

People who have used cocaine for a long time report a paradoxical-seeming experience: The pleasure they get from taking the drug decreases even as the drug intensifies its hold over their behavior.

A recent NIDA-supported study sheds light on why this might be. Researchers shows that, in mice, a cocaine-induced imbalance in the activity of two key populations of neurons in the reward system persists for a longer period after repeated exposure to the drug. For long-term users, the researchers suggest, this change could both weaken the cocaine “high” and strengthen the compulsion to seek the drug.

A Distorted Ratio

Drs. Congwu Du and Yingtian Pan and colleagues at Stony Brook University in New York and at NIDA injected two groups of mice with a single dose of cocaine (8 milligrams per kilogram of body weight). One group of mice had already been exposed to the drug daily for 2 weeks, and the other, a control group, was receiving the drug for the first time. Using a novel dual-imaging and measurement technique*, the researchers tracked the drug’s impact on activity levels of two populations of medium spiny neurons (MSNs) in the striatum of the two groups of mice.

One of two MSN populations observed by the researchers interacts with dopamine via receptors called D1R. When activated by dopamine, striatal D1R MSNs give rise to pleasurable feelings, motivate an animal or a person to repeat the experience that yielded these feelings, and promote the conversion of such motivation into action by stimulation neurons in the brain’s motor cortex. The other MSN population interacts with dopamine via a different receptor, called D2R. When activated, D2R MSNs counter the effects of the D1R MSNs. They attenuate euphoria and drug seeking and inhibit the motor cortex.

In the experiment, Drs. Du and Pan found that immediately after the cocaine injection, D1R MSN activation increased and D2R MSN activated decreased, both in the mice that had been exposed daily to the drug and in those being exposed for the first time. As a result, in both groups, the ratio of D1R MSN to D2R MSN activation shifted sharply in favor of the D1R MSNs and their reward- and motivation-promoting effects.

At 5 to 7 minutes post-injection, however, the D1R to D2R activity ratios diverged between the two groups of mice. In the control mice, D1R activation rapidly fell back to its baseline level, causing the D1R to D2R ratio to also return to near baseline. In the mice that had been exposed daily to cocaine, in contrast, the cocaine-induced D1R activation increased steadily over the entire 30 minutes that the animals were observed. As a result, D1R to D2R rose higher and remained elevated longer in the daily-exposed mice holds in people as well, it could help explain why long-term users of cocaine report less euphoria from taking the drug.

The researchers propose that the drawn-out time course of cocaine-induced D1R to D2R MSN activation following repeated exposure will also enhance an animal’s or a person’s drive to seek the drug. Dr. Pan explains, “Dopamine both activates and inhibits brain circuits, and normally this dual action produces healthy behavioral outcomes. Cocaine upsets this balance. It enhances the D1R MSN signaling that normally puts a brake on those behaviors. In our experiment, we showed that this imbalance is short lived in mice when they are exposed to the drug for the first time, but long lasting in mice that have already been repeatedly exposed.”

More Research is Needed

“The research field had not put much effort into separating how these two dopamine receptor systems are involved in rewiring the brain exposed to chronic cocaine use, or their effects on compulsive intake of the drug,” says Dr. Nora D. Volkow, NIDA Director and a collaborator on the study. “This work highlights the importance of the relative participation of D1R versus D2R signaling.”

Drs. Du and Pan have more work to do to show that their observations account for long-term cocaine users’ reduced enjoyment and increased compulsion to use the drug. As a first step, they plan to examine whether increasing the D1R to D2R MSN activity ratio indeed increases animals’ drug-seeking behavior. This will be very challenging, says Dr. Du, because it will require adapting their imaging technique to monitor MSNs in awake and moving animals. To date, they have used it only with anesthetized and restrained animals.

Another outstanding question is whether long-term cocaine use actually changes the time course of D1R MSN activation in people as it does in mice. Dr. Pan notes that although research has not yet addressed this question, imaging studies conducted in Dr. Volkow’s laboratory have shown that cocaine dampens D2R signaling in people as well as mice. If further investigations confirm the researchers’ hypotheses, says Dr. Volkow, “treatments that strengthen D2R signaling could help people stop using cocaine.”

Source

Park, K.; Volkow, N.D.; Pain, Y.; Du, C. Chronic cocaine use dampens dopamine signaling during cocaine intoxication and unbalances D1 over D2 receptor signaling. The Journal of Neuroscience, 33(40):15827-15836, 2013.

*To achieve their observations, Drs. Du and Pan developed a dual-imaging technique based on a novel microprobe that was used for visualizing individual neurons deep within the brain. The technique enabled them to distinguish the populations of D1R and D2R MSNs, and to track moment-to-moment changes in each one’s calcium levels. Calcium levels directly reflect a neuron’s level of activation.

The Anatomy of Alcoholism

Many different types of people become alcoholics, but all alcoholics are ultimately alike. The disease itself swallows up differences. The personality changes that go with the illness of alcoholism are predictable and inevitable. Alcoholism can destroy the physical, emotional, spiritual and mental life of the sufferer.

Early drinking is characterized by a mood swing in a positive direction. It creates a warm and fuzzy feeling, and may even lead to giddiness. When the effects wear off, the drinker feels normal. It does not take long to learn how to set the amount and select the mood. As the typical social drinker gets deeper into the booze, getting drunk begins to have a very different effect. Heavy drinking creates a sort of undertow that drags the drinker below normal and into pain. At this point, booze is often consumed simply to not feel pain. In other words, to get back to some degree of normal. This is the beginning of harmful dependence.

This dependency has a rising emotional cost. There is typically a significant and progressive deterioration of the personality of the alcoholic, and often even a visible physical deterioration. Ultimately, the alcoholic’s whole emotional environment is torn up and destroyed. There is an emotional cost for every drink. The carefree days are gone. Of course, the alcoholic is dimly aware of this fact. For some reason, the rising cost is willingly paid. This is proof that dependency on booze has become truly harmful. Of course, the drinker fails to comprehend the increasingly clear signs of destruction by alcohol.

The alcoholic is learning to live more and more by way of rationalization. Intellect will blindly defend against reason, against intervention, and will hide disintegration, right up to the edge of the abyss. Eventually, the alcoholic will be completely out of touch with his or her emotions. Internal dialog will become the audio of an increasingly impenetrable defense system.

The tragedy is that rationalization works. This form of defense continues to operate ever more successfully as the disease progresses. As time goes on, the alcoholic’s behavior will become increasingly bizarre, and the innate and unconscious ability to rationalize will be practiced to the point of perfection. The alcoholic finds it increasingly difficult to accept blame. Time passes, and the condition worsens. Over a period of months and years the alcoholic’s self-image continues to wane. Feelings of self-worth sink low, and excessive drinking continues. Eventually, emotional distress becomes a chronic condition. The drinker feels distress unconsciously even when not drinking. The mantra is I’m just no damn good.

Mood swings and personality changes are evidenced while drinking. The otherwise kind person becomes angry or hostile; the usually happy person becomes sad and morose; the normally gentle person becomes violent. Alcohol causes the guard to drop, and chronic unconscious negative feelings are exposed. The drinker becomes truly self-destructive. All this drinking and emotional distress may lead to a vague but poignant feeling that a problem exists. There is a general malaise so strongly felt that desperate measures to escape are proposed or actually attempted. Geographical cure, new job, divorce.

Continued excessive drinking and accompanying behavior bring on chronic fatalistic feelings. If the course of the disease is not interrupted, the end of all this is suicide, either slowly with alcohol, or in a direct or deliberate manner. We need to remember that as emotional distress mounts and deterioration of the personality accelerates, these negative feelings are not clearly discernible. Quite the opposite, they are more and more effectively hidden.

You may wonder if you have a drinking problem. Ask yourself the following questions. Have you ever drank in the morning? Have you ever drank alone? Have you ever drank a fifth a day? Have you ever felt remorse after drinking? Do you have a growing anticipation of the welcome effect of alcohol? Has it moved from anticipation to preoccupation?

There is another principle to be applied when examining whether you are an alcoholic. Is there evidence of a growing tolerance to alcohol? Does it take more and more for you to get the same welcome effect? Do you sneak drinks in the kitchen before bringing other drinks in to the living room or the den? And to what lengths are you willing to go to get that extra amount of alcohol? The degree of ingenuity used to get more becomes the scale for determining how dependent you are on alcohol. All instances of harmful dependency that turn up in the behavior patterns of the alcoholic at this stage of addiction indicate a growing anticipation of the welcome effects of drinking, an increasingly rigid expected time of use, and a progressive ingenuity in obtaining larger and larger amounts of alcohol.

Rational defenses and projection set in. Why is it that the alcoholic cannot see what is happening to him or her? The answer is, simply, because they can’t. The reason alcoholics are unable to perceive what is happening is understandable. As alcoholism develops, self-image continues to deteriorate, and ego strength ebbs. For many reasons, alcoholics are progressively unable to keep track of their own behavior, and begin to lose contact with their emotions. Their defense systems continue to grow, so that they can survive in the face of their problems. The greater the pain, the higher and more rigid the defenses become; and this whole process is unconscious. Alcoholics do not know what is happening inside of themselves. They’re victims of their own defense mechanisms.

As emotional turmoil grows in chemically dependent people, rational defense activity turns into real mental mismanagement, which serves to erect a secure wall. The end result is that the alcoholic is cut off from increasingly negative feelings they have about themselves. They are unaware of the presence of such destructive emotions. Not only is the drinker unaware of the powerful highly developed defense systems, they are also unaware of the intense feelings of self-hate buried inside them. Moreover, the problem is compounded by the fact that these defenses have now created a mass of chronic free-floating anxiety, guilt, shame, and remorse. In other words, the alcoholic no longer starts drinking from the “normal” point (where they could always start before), and swing up in mood to feeling great or euphoric; rather, they must start from where they feel depressed or pained and drink to feel normal.

Alcoholics drink because they are alcoholics. As a Chinese proverb says, “First the man takes a drink, then the drink takes a drink, then the drink takes the man.” At this stage, the drinking pattern becomes thoroughly unpredictable or compulsive. The alcoholic quits, then resumes, and does not know why he or she starts drinking again. The resumption is at the level of chronic emotional deterioration. Conditions worsen with each new episode. The drinker is trapped in a deadly downward spiral.

Chemically dependent people have two factors progressively working together to draw them out of touch with reality. First, there is their defense mechanisms. Second, there is their distortion of memory. Either one of these alone would seriously impair judgment. The time inevitably comes when the alcoholic cannot see that he or she is sick. In reality, they are acutely ill with a condition that will ultimately lead to death, and which will seriously impair their constitution emotionally, mentally and spiritually during the final months or years.

Treatment for acute alcoholism is not merely concerned with putting the drink down; it also has to do with restoration of adequate ego strength to enable the drinker once again to cope with life. Therapy for acute alcoholics must address the whole person. The alcoholic suffers emotionally, mentally, physically and spiritually. Often, treatment involves physicians, clergy, psychologists, sociologists, pathologists and psychiatrists. If the whole person is not treated simultaneously, relapse is inevitable. If, for example, the emotional disorder alone is addressed, the drinker may believe they feel so good now that they can handle the drink. It’s like having two broken legs, but only seeking treatment for one.

If you’re struggling with alcoholism, realize that you are ill on numerous levels. The problems linked to alcohol dependence are extensive, and affect the person physically, psychologically, emotionally, spiritually and socially. Drinking becomes a compulsion for a person with a drinking problem. It takes precedence over all other activities. Alcoholics are obsessed with alcohol and cannot control how much they consume, even if it is causing serious problems at home, at work or regarding finances. The alcoholic is viewed as dealing with a physical allergy to alcohol, a mental obsession to keep on drinking, and an underlying spiritual malady that means willpower is not enough. Unless all three aspects of the condition are treated, the drinker will not be able to escape his or her addiction.

Many people lead lives of quiet desperation, trying to fill the God-shaped hole in their soul and cover the pain with shopping, eating, gambling, and a million other distractions. But addicts and alcoholics are physically predisposed to escape or numb themselves in ways that go directly into a downward spiral of self-destruction. When I drink or take drugs, my life is little more than an isolated routine of coming to, muddling around, getting drunk, or taking Vicodin or Oxycodone, in order to make things fuzzy until I pass out. Of course, this is little more than sleepwalking through life.

After getting “sober,” I returned to church. I considered myself a “Christian in recovery.” Although I was able to stay away from alcohol, marijuana and cocaine since 2008, I started abusing narcotic pain killers. I was teaching Bible study at the county prison, but I was hiding my addiction. I was in denial. I wish more pastors didn’t still view addiction in primarily moral terms. Yes, addictive behaviors often begin with a moral failing like selfishness or overindulgence. But full-blown addiction is a disease that involves physiological and psychological components that go beyond sin or even choice. Trying harder, reading the Bible more, or praying more are rarely the solution.  I have finally come to believe that I cannot drink or use opiates safely no matter how spiritual I may think I am.

I, like Paul, war against my flesh. He said, “For the good that I would I do not; but the evil which I would not, that I do…Now if I do that I would not, it is no more I that do, but sin that dwells in me.” (Romans 7:16,20) The magnitude that one’s spiritual life plays in recovery from addiction is hard to measure. I do believe, however, that without addressing the spiritual malady of alcoholism, recovery is often no more than just putting the cork in the bottle with little lasting effect. I want to make something absolutely clear. A spiritual approach alone, without working a recovery program specifically for addiction, is problematic. Worse, it’s all too easy for addicts and alcoholics to convince themselves they’re covered through meditation or church attendance or the blood of Jesus. They tend to do nothing to address their addiction, their character defects, or their self-centered fear.  Remember, faith without works is dead. Thankfully, I know Christ died on the cross that I might live my life free from the bondage of addiction. It is now up to me to take certain steps.

 

 

Share Christ, Love People

I have to admit that I initially came to Christ at a fairly young age of thirteen. I was in junior high school. Our family was very involved in a local Bible church. We attended Sunday school every week, then stayed for worship and the sermon. Our pastor was very dedicated. Very charismatic. I felt led by the Spirit when he spoke. He had my undivided attention, and that was rare at my age. He often became emotional, and was not ashamed to let his congregation see him cry. We would come back to Church at 7:00 Sunday evening for an evangelistic hour live on a local FM radio station. Our pastor would preach the Good News, talk about sin and repentance, and the sin solution. He would invite listeners and and people in the church to accept Jesus Christ as their personal Lord and Savior. It was very moving. Our pastor was reaching out the hand of hope. It is unfortunate that he announced one Sunday morning that he was being called away to start a new church. Many were devastated. I had taken a strong liking to his youngest daughter, Faith, and was sure I would miss her.

His final sermon was electrifying. He spoke of our duty as Christians to share Christ. He made me think, even at the young age of thirteen, of what type of difference I could ever hope to make. It felt right. It felt possible. Perhaps with some work, with some education, and with somewhat of a change of heart. You know, the kind of change that comes with growing up and putting others first. I just didn’t think it would take me nearly forty-two years to grow into that role. It was during this time-period that I struggled with wrong-living. I went over to the dark side. Hung out with the wrong people. Discovered marijuana and booze, broke the law, and was sentenced three years in state prison. My drug use grew worse over the years, culminating in a falling out with my family.

Fortunately, God was not through with me yet. Facing homelessness, my family allowed me to move in with them. Dad and I talked a lot about what I was going to do differently this time. I applied for welfare benefits and underwent a drug and alcohol evaluation. I was approved for an intensive outpatient program, attending several group sessions and one individual session per week. I was a patient of that service for one year.

It was at this same time that my father introduced me to one of the neighbors on his block, an associate pastor at a local Pentecostal Church. Reverend Bob. He invited me to attend church with him. It was a small Pentecostal church in a basement. Membership was about thirty-five. A nice worship team. I knew I found a church where I could grow. I fit right in from the first. After all, I’d just come off a six-year-long run of drinking and smoking marijuana and basically living from jobsite to jobsite. I was recently diagnosed with bipolar disorder and anxiety disorder on top of polysubtance abuse. I was hurting, and I was ready for a respite. The members rallied around me, loving me until I could love myself.

Did I do everything right? No. I was able to quit drinking and smoking pot, but I continued to struggle with opiates. My depression and my back disability defeated me. I began taking a lot of Percocet and Vicodin. I would go to multiple sources, many times paying cash. I couldn’t keep up with the need, and started taking pills belonging to family members. Unfortunately, during this time I was attending AA and chairing meetings. I even sponsored a few men. But this type of situation always gets worse, never better. I ended up overdosing on Tramadol and being rushed to the ER in an ambulance. You would think that would have got my attention. Unfortunately, I kept stealing medication and eventually got caught. The family put me through an intervention, and I agreed to spend twenty-one days at a drug and alcohol facility.

That turned out to be the best decision I’ve ever agreed to make. I wasn’t really scared. I was relieved. Something had to give. I was living a lie. Making a mockery of my Lord and Savior. Pretending to be a sober life coach. Praying. Attending church. Telling everyone everything was okay. But I was suffering silently. Slowly dying inside. Figuring nothing was ever going to change.

I did a lot of praying while in rehab. I brought a Recovery Bible with me. I knew I had only one recovery left in me. This was it. Fifty-five years old, on disability, sitting in a rehab after thirty-seven years of drinking and getting high. No prospects for the future. No time to put a new career or life together. Twice divorced, no idea what true love was. Two sons. No idea how to be a father. But I didn’t feel done. I had God. I had a faith I believed in since I was a young man. I had a spark deep down inside me that said I belonged to Him. He was not done with me yet.

And so it is for this reason that I choose to serve the Lord. I was saved for a purpose. I’ve been in many places where I didn’t belong. I’ve driven drunk. I’ve committed crimes. I’ve walked down long dark allies in Philadelphia to buy crack. I’ve snorted cocaine. I’ve tried PCP and model airplane glue and mushrooms and all kinds of pills. I gave myself over to the dark side for decades. It’s no secret that anything could have happened. I’ve met many men just like me over the years. Some die. Others end up in prison for years. Some take their own lives. Then there are those of us who feel we’ve been saved in order to save others. This was brought to my attention this past weekend at our Mens’ Conference. God has set me free from the bondage of addiction. His ministry is one of forgiveness and redemption, not condemnation. My sins have been paid in full. God has called me to the ministry of helping others who suffer from addiction. After a year of dedicating myself to servicing my own local church, I plan on entering Bible college. I will never forget the day I told my grandmother that I felt led to join the ministry. I told her every time I turn my back on the Lord I end up in trouble.

Thank you Lord for saving me from myself, and for giving me a purpose.