New Directions Program
7996 Old Winding Way, Fair Oaks, CA
A member of our staff, Philip Hodson, recently contributed some web content for Florida Beach Rehab, located in Hutchinson Island, Fl, on the pathologies and dangers of enabling behavior. If you'd like to read the article, simply click on the link below:
www.floridabeachrehab.com/pathology-and-effects-of-enabling/

Our April Newsletter centered on the importance of nutrition and appropriate supplements in recovery:

For most addicts and alcoholics in early recovery, it comes as a surprise (or shock) that the problems and stressors in their lives do not simply evaporate once they have achieved abstinence. Unfortunately, as the described in the Big Book of Alcoholics Anonymous, “Our liquor was but a symptom,” (Fourth Edition, New & Revised, 2001) of the disease of addiction. What this means, of course, is that the real work of recovery begins once the body and mind are free of the chemicals in alcohol and drugs of abuse. With good reason, a lot of the activities involved in recovery are directed at resolving or ameliorating emotional and psychological difficulties experienced by those in active addiction or early recovery. While this is unavoidable and entirely necessary, we find it curious that so little attention is paid to the physical aspect of recovery.


There is plenty of information and education available on the deleterious physical effects of alcohol and drugs, but there is little awareness of what can and should be done to repair these effects. To be sure, the body and brain will begin to repair themselves once they no longer require or are forced to compensate for the presence of drugs and/or alcohol, but, first, this can be a lengthy and uncomfortable transition, and, secondly, returning to a previous physical state is not always the same as returning to a state of better health. Few are the clients who eat well, exercise regularly, adhere to a strict regimen of vitamins, minerals, and supplements and also happen to be chronic abusers of either alcohol or drugs. More commonly, physical or psychological dependence on one or more mind altering substances is indicative of a pattern or history of poor lifestyle decisions. So what should we consider when advising clients on improving their overall physical and mental health in recovery?


Let’s begin first with suggestions for basic dietary changes. The most basic of all recommendations to anyone in early recovery is to NEVER skip a meal. Ideally, we want breakfast to consist primarily of protein and dinner to be more heavily comprised of carbohydrates, and we want all meals to be well-balanced and healthy, but if clients are either unable or unwilling to follow these more specific guidelines, they must make every effort to eat at least three meals a day. When having this discussion, we always mention at least these two important facts: first, the brain uses between twenty and thirty percent of the calories we consume at any given time, and secondly, eating refined sugars and/or carbohydrates or skipping meals can contribute to dangerous swings in blood sugar. If a client in early recovery is not getting adequate fuel to his brain, he may be more prone to making impulsive or ill-advised decisions. This can be exacerbated by inducing hypoglycemia by not eating regularly. The symptoms of what is known as “Dry Drunk Syndrome” are almost identical to the symptoms of hypoglycemia. When blood sugar is low, the brain instructs the kidneys to release adrenaline to increase the amount of blood glucose, and, while providing an energy source for the brain, adrenaline also increases the level of activity in the amygdala, which can lead to agitation, impulsiveness, and aggression.


Once clients begin or are willing to begin eating regular meals without skipping, we want to be sure they are eating the right stuff. It’s not uncommon for addicts and, in particular, alcoholics to increase their sugar consumption in early recovery. This can occur either because they are replacing the sugar from alcoholic beverages with sugar from sweets, sodas, or foods high in starch, or because of the ability of sugar to temporarily raise the level of neurotransmitters like endorphins and dopamine. Unfortunately, when they are on the other side of this “high”, they will be even less capable of coping with the rigors of early recovery than they were before consuming the sugary or starchy snack. While pushing for greater intake of green, leafy vegetables, we want to ensure that clients are getting adequate quantities of proteins and good fats. Proteins are essential in the creation of neurotransmitters, enzymes, muscle, bone, tendons, and energy in general. Good fats are just as integral to the creation of cell membranes and myelin sheaths that surround the axons of nerve cells (neurons), insulating the electrical impulses that ultimately lead to the release of neurotransmitters. Along with helping to insure the proper transfer and reception of signals in the brain, proteins and good fats help to keep us focused on the present task and provide longer-lasting energy, making us less desirous of short-term boosts in energy or mood. In short, they help to keep us balanced. When discussing proteins with clients, we talk about the following sources: lean meat (turkey, fish, chicken), and raw nuts and seeds, to name a few. For good fats, we talk about flax seed oil, eggs, and avocado, among others.


Most of what is written above can apply to anyone in recovery (or anyone, period), but there are further modifications and additions that are more specific. It is widely known that various drugs of abuse—including alcohol—can mimic, stimulate the release of, or prevent the reuptake of neurotransmitters. Over time, the brain and central nervous system (CNS) change to compensate for the presence of drugs and alcohol. Drugs and alcohol affect the brain and CNS very quickly, but their respective effects are relatively short lived. The changes our bodies make, however, occur on a much longer timeline and can take months to unwind. Thus, when one stops using or drinking, the body is free of those substances in a matter of days, but the brain and CNS continue to behave as though the drugs and alcohol are still “on board.” If the drugs an addict was using had the effect of exciting the CNS, then the changes her body made to compensate were designed to counter this effect, to inhibit the CNS. With no drugs to balance her body’s response, the body over-compensates, and this can lead to some of the symptoms of acute and post-acute withdrawal. Amino acid therapy can ease the transition from active addiction to recovery by damping the effect of this over-compensation.


We usually focus on four amino acids and their resultant neurotransmitters: GABA, L-tyrosine (catecholamines), 5-HTP (serotonin), and D and DL phenylalanine (endorphins). If we know what substance clients were using, then we can have a pretty good idea of the withdrawal symptoms they should expect and can, then, recommend a course of amino acids. If, as is often the case, a client reports that he used a particular drug because it mitigated the symptoms of anxiety, depression, or other such feelings, then this may indicate the presence of an undiagnosed mental health issue that exists because there is too little or too much of one or more neurotransmitters.To make a formal diagnosis, we would, of course, refer the client to a psychiatrist, but if there is an amino acid that can not only make withdrawal less difficult but also improve the client’s overall mental health, then we have an opportunity to really cut down the chance of relapse in the longer run by making amino acids part of daily regimen.


In the interest of keeping this newsletter at a manageable length, we’ll stop here for the time being and pick up next moth with a discussion on vitamins, other supplements, and exercise. We hope the information above has been helpful. It’s possible, though, that you may have questions or need clarification on certain points. Should this be the case, please do not hesitate to contact us either on the phone, at www.newdirectionsca.com, or by replying to this e-mail, and we’ll be happy to get back in touch as soon as we can. Thanks as always, and have a great month.


All the best,


Phil




Our March Newsletter focused on the current trends and dangers of the 
growth in e-cigarette use. To read about the CDC's new campaign against nicotine addiction and our thoughts on the subject, please continue reading:

We interrupt your regularly scheduled newsletter to bring you this special report…


We intended the focus of our March newsletter to be the Recovery-Specific Diet, but after learning of the Centers for Disease Control and Prevention’s (CDC) new round of advertising on the health risks of smoking—which for the first time addresses e-cigarettes—we decided to report on this news and give you our impressions.


The smoking of e-cigarettes—or “vaping”—has been going on in the United States for about seven years, but the practice has become much more pervasive recently. There was a flurry of reports published domestically and around the world in the third and fourth quarters of last year, and because of the CDC’s renewed focus on smoking in general, more reports will likely be out in the near future. To our thinking, there are two different discussions we can have on this subject: first, is vaping a safe(r) alternative to smoking regular cigarettes (e-cigarettes work by heating a liquid solution by a battery-powered element that is then atomized and inhaled as a vapor) because it eliminates the tar and other carcinogens found in regular cigarettes? And secondly, what special considerations should be taken when discussing these products with clients in recovery from substance abuse? We will address the first question first.


And the answer is… We don’t know. A study conducted last year by a team of researchers in Japan found that the amount of formaldehyde found in the liquid of one e-cigarette was ten times that of a normal cigarette. But these claims were not published, and only one of the ten e-cigarettes tested produced these results (Thomas J. Glynn, Professor at the Stanford University School of Medicine on WBUR, November 28, 2014). Still, formaldehyde has shown to be present in these liquid solutions, as has acetaldehyde, the same chemical produced during the partial oxidation of alcohol by the liver enzyme alcohol dehydrogenase. Regardless, the idea of safety does not rest solely on the liquid’s chemical make-up: The head of the CDC, Tom Frieden, stated that approximately three quarters of people who use e-cigarettes continue to smoke regular cigarettes (WBUR, March 30, 2015). The BBC reported today that a survey published by BMC Public Health, which surveyed children between the ages of 14 and 17, showed that one in five reported having either used or bought e-cigarettes (BBC, March 31, 2015).


We could go on about other disturbing trends, both emerging and forecast, but this is a newsletter and not a news roundup, so let’s distill things a bit. For the sake of argument, let’s say that e-cigarettes pose no increased risk of exposure to carcinogens versus regular cigarettes. In fact, let’s say e-cigarettes reduce said exposure. All things being equal, it may be fair to say that vaping is safer than smoking regular cigarettes. Unfortunately, all things are not equal. If you continue to smoke regular cigarettes while also using e-cigarettes, you will—at best—reduce the potential benefits of vaping. If you begin vaping at an early age and, by doing so, become addicted to nicotine, then you are addicted to nicotine; the only difference is the delivery system. Further, Karen Hughes, a professor of Behavioral Epidemiology at Liverpool John Moores University and author of the study released by BMC Public Health, said, “We found that e-cigarette access is strongly related to alcohol use in teenagers.” So what, exactly, does ‘safe’ mean? We’ll leave you to draw your own conclusions.


As to the second question, is nicotine addiction not an addiction we should discuss with our clients? At New Directions, we believe smoking cessation, FDA-approved nicotine replacement therapies (e-cigarettes are not approved by the FDA), and other forms of medication-assisted treatment (MAT) are essential to a comprehensive approach to substance-abuse treatment. From here we could discuss triggers (smoking or vaping can be a trigger for any inhaled substance of abuse), process or cross addictions, reservations, retention of habitual behaviors associated with alcohol or drug use, harm reduction versus abstinence, or any other of the many topics that come to mind when we are attempting to help a client change his or her attitude to addiction. But if we look at it thematically, helping a smoker move to an e-cigarette is analogous to helping a heroin addict get a prescription for Norco.


Now before you tell us that we’re crazy or that we don’t understand how difficult it is to get addicts and alcoholics to quit smoking, please notice we said ‘analogous’, not ‘tantamount.’ We are well aware of the difficulties associated with helping clients be free of tobacco and nicotine, but that does not mean that we stop advocating for change. There is a time and a place, to be sure, and we certainly focus on the substance-abuse issues as primary, but we are also keenly aware of the fact that keeping one foot in recovery is only made more difficult by keeping the other in addiction, no matter the kind.


As ever, we thank you very much for taking the time to read our newsletters, and we look forward to bringing you The Recovery-Specific Diet edition next month.



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