Causes of Addiction from a Trauma Informed Perspective

Hey there everybody, and welcome to this presentation on the causes of a trauma informed approach. I'm your host, Dr. Donnellice Snipes. In this presentation you're going to learn about addiction, the prevalence, what we think are some of the causes, the functions of addiction and develop an understanding of how addictive behavior, regardless of the origin, often ends up being a form of of self medication. Let's start out with the statistics. Part. 16.3 million adults ages 18 and older, or about 6.8% of this age group, had an alcohol use disorder in the 2014 Drug Addiction Survey. Now 2014, I know that's a while ago, they don't do these surveys all that often, or at least they don't publish them, but online, all that often. But remember this was before the pandemic. We know that now the pandemic has occurred or is occurring that the levels of substance misuse, as well as depression and anxiety and other issues have skyrocketed. In 2013, an estimated 24.6 million Americans, or 9.4% of the population, had used an illicit drug in the past month. Now in 2013, just kind of going back historically a little bit, remember that marijuana was not legalized in a bunch of states back then. So marijuana counts towards the illicit drugs. Either way, it's important to recognize that there is a significant amount of substance use whether it's legal or not. If people want it, they are going to find it. About 47%. Yes, you heard me right. 47% of the US adult population suffers from an addictive behavior with serious negative consequences in any 12 month period. Now that includes things like compulsive gambling, smoking, drug addiction, alcoholism. So there are a lot of things, porn addiction, that, there are a lot of things that fall under that umbrella. But just sit back and think about that. That's basically half the people, half the adults in the US are struggling with a behavior that is designed to help them escape from unrelenting pain. That is heartbreaking. What is addiction? We know that people drink alcohol, we know that people use other substances and don't develop addictions. So what is addiction? Addiction is the use of a pleasurable activity or substance. So basically something that is going to cause the brain to secrete dopamine and serotonin and some of those feel good chemicals. So the use of a pleasurable activity or substance to escape emotional or physical pain, that continues to be used. And this is the big issue that continues to be used despite causing problems in one or more areas of life. Some people may start out with recreational use and, you know, not have a problem. And then life sends them a curve ball, they start using more heavily. Well, unfortunately, when we start using more heavily, when it's not just this occasional thing, the brain actually starts making changes, and the body starts developing a tolerance, which means needing more of the same substance or activity. Or combining substances or activities to get relief. And the brain does this because when we are engaging in an. In an addictive behavior, we're basically flooding the system with happy chemicals. And just like any flood, Too much for a long period of time Is going to cause damage. So the brain says, I'm going to put up some blockages. I'm going to keep so much of that, those happy chemicals from going through. So I don't overstimulate the. Overstimulate the system. So tolerance is actually our body's way of saying, I want to survive. Withdrawal occurs when we quit flooding the system. And we go back to the normal amount of happy chemicals to make it very simple. And then the body is used to getting that flow. It's used to having that increased pressure of the happy chemicals coming through. Now all of a sudden, it slowed to a trickle. And so now we don't have enough, and we start feeling poorly. Now, it's important to recognize Addiction is no more of a choice Than diabetes or heart disease. Okay, Using substances, that's a choice. Whether you drink alcohol, Whether you use something else, whether you watch porn, that's a choice. But the brain changes that occur that develop into. And the body changes that develop into addiction, that's not a choice. And unfortunately, since we don't know who is going to be more susceptible or when they're going to be more susceptible, it's hard to know what's a safe amount of use. But I digress. The key here, addiction, the condition, the disorder, Is no more of a choice Than diabetes or heart disease. Using the substances or engaging in addictive behaviors to escape pain despite negative consequences Is a choice. And Even in the 12 steps, the only requirement for 12 step programs is a sincere desire to stop using, A sincere desire to make alternate choices when you want to use to choose something else. There are a lot of theories of addiction, and as I said, we really still don't understand exactly what causes it or why one person might develop it and another one doesn't, Even if they're living in the same family. So there are some theories. The moral, or what I call the behavioral model. Attributes the development of addiction to human weakness and defects of character. Treatment involves focusing on Choices to become the person you want to be. And the moral model is very choice driven, Very cognitive, behavioral in nature. The disease model says that addiction is an illness that occurs Due to impairment of healthy functioning of the body. And a lot of times they'll talk about diseases as being progressive, incurable and fatal. So let's just look at that for a second. Progressive. When people are using, if they use frequently or consistently, the body is going to adapt, they're going to develop tolerance, so they're going to need more, and then the body will adapt to that, and then they will need more. So, yes, this is progressive. The problems that are occurring in their life As a result of their addictive behaviors Are also probably progressive, incurable. What does that mean? That means that someone who develops an addiction Is always going to be at risk of relapse, Basically because their body knows their body reacts in a certain way to that substance. Their body remembers, their brain remembers that that was one tool in their toolbox. And it's not like they suddenly, poof, don't remember the euphoria from when they were using. So the threat is always out there. So we can't just say, all right, you're cured, you can go back to doing whatever. There is an element there that there is always risk for the person with, with an addiction, and fatal. As the addiction progresses. As the system becomes progressively imbalanced, the neurotransmitters, the hormones, as well as the damage that's done to the body as a result of the addictive behaviors, it ultimately can become fatal. The disease model is one that is largely embraced by the medical community right now. Genetic predisposition has been also proposed as a theory for addiction. There are some people who have genes that make them more responsive to the effects of certain drugs, for example. However, they haven't been able to effectively ferret out or differentiate the impact of genetics or from social learning and environmental factors. People with certain genetics may live in the same family, so they're exposed to a lot of the same messages, experiences, situations, resources as each other. So differentiating why one develops addiction and one doesn't, they have difficulty with. They have shown in some twin studies that there are genetic components to it. Again, where certain people may be more highly reactive to certain substances and their body may be more susceptible to more quickly developing tolerance, withdrawal, etc. The social learning, cultural environmental model, however you want to call it, indicates that a lot of addictions are caused by people seeing other people using and choosing to start using. And that behavior is reinforced and it's like, oh, come on, just have one more. It's the peer pressure model, if you will. And as a result of that, people develop. And this is more of a habit based model or a culture based model where excessive drinking, for example, is the norm. The blended model basically says yes to everything up here. We know that addiction is a disease. We know that our choices can cause disruption in the body. Just like eating a lot of sugar will cause your insulin to spike. We know that our choices can cause changes in the body. And we know that through recovery, making alternate choices can help people address particular issues. We know that our society does tend to promote addictive behaviors. There are a lot of messages about pleasure and consumption. And we also know that there, as I said, there is a certain genetic predisposition. When I talk about causes of addiction, I really like to get down to what's going to tolerance and withdrawal. The physiological, what's going on. There are risk factors that we're going to talk about in a minute. But the causes of addiction. People can drink alcohol periodically, a lot of people, and if they're not doing it to excess repeatedly, they're not causing brain changes, then the body naturally balances back out again. They may have a hangover the next day if they drink too much. But the neurotransmitters and hormones and everything else will likely start getting back into balance on their own. When someone is excessively using and they start to develop that tolerance, then the brain starts actually under undergoing changes. Neuro neurons and receptors are pruned back. There are alterations in the physiological system. And that's when we start to see addiction. Because when the person starts to try to cut down or quit, then they don't have enough of the pleasure chemicals. They don't have enough of whatever they were trying to self medicate with. So they start thinking about it and perseverating on it or obsessing about it. If I could only have a drink. They start neglecting important areas of functioning. And this can lead to depression and anxiety and desire to escape again. When our neurotransmitters get out of whack, it causes mood symptoms, it causes cognitive or thinking problems. And when we feel this way, sometimes people will try to numb that with using more substances. They're like, well, when I'm using, it doesn't hurt this bad. Neurotransmitter issues can be caused by a bunch of different things. And I think it's important that we recognize this. Inadequate nutrition or not providing the body the building blocks to make the Neurotransmitters is a problem. People who grew up in deficient environments where they weren't able to get their nutritional needs met, may have been going for a long time without having enough building blocks to keep their neurotransmitters in a healthy balance. So they may be experiencing depression or anxiety or other issues, difficulty concentrating. And sometimes people will find that a substance because it causes a surge of those chemicals may help them feel a little bit better. But inadequate nutrition is a problem also in recovery. If people don't have good nutrition, then they are not going to be able to make the building blocks to help their body recovery, repair and rebalance. We can also have neurotransmitter imbalances due to dysfunction in the manufacturing process. I don't know what else to call it. If the body doesn't have all of the vitamins and minerals it needs, if it doesn't have all the resources it needs in order to break down the building blocks and make the neurotransmitter. And a lot of them are actually made in our gut. So if your gut microbiome is wonky, which happens especially with chemical substances of abuse, then the body may not be able to adequately make the neurotransmitters. You can also have a disruption in the neurotransmitter balance if the body is using a particular neurotransmitter faster than it can be made. So we only have a certain amount of dopamine, for example, if we are just peddled in the metal using those pleasure activities or substances, we're flooding the system with dopamine. At a certain point, there's none left to put into the synapse. So that can be a problem. Once neurochemicals are in the synapse in the brain, they sit there for a while and they're absorbed and moved on down the pathway. But if they're not allowed to sit there for long enough, kind of like if you take a sponge and you just drop it onto a spill and pick it back up again, and you're like, well, it didn't absorb anything. You know, if they're not allowed to sit there long enough, then they can't do their job. So if the enzymes that are responsible for basically breaking down the neurotransmitters in the synaptic space, packaging them up and putting them back up on the shelf again. If they do their job too quickly, then that can prevent enough of the neurotransmitter from getting downstream. A lack of receptors. Remember I said when people are engaging in addictive behaviors and flooding the system, a lot of times the brain will actually prune off some of those receptors because it says we don't. You know, normally we needed all these receptors in order to keep things going, because there wasn't a whole lot. And. And we needed to be able to reach out in as many places as possible. But we've got so much we don't need to be able to reach out with 16 hands, two hands has got it. So the brain may have pruned away some receptors. Now, the good news is the brain actually can undergo something called neurogenesis that helps it repair itself to a certain extent during the recovery process. And finally, neurotransmitter imbalances can be caused if for some reason the body can't transmit or the brain can't transmit that nervous signal, can't transmit the message from the neurotransmitters downstream. So it would be like picking up a telephone and dialing it, but the message couldn't get out. Any of these things can be. Can cause depression, can cause anxiety, can cause mood disorders or mental health issues. That can set somebody up to be at risk for developing addiction. People who have experienced trauma may be under stress a lot. So their HPA axis or their threat response system is constantly on, which means their body is constantly receiving input of adrenaline and cortisol and norepinephrine. And the body will respond to an overactive HPA axis, just like it responds to excessive input as a result of drug use. And it will undergo changes. Addiction causes physiological changes that are similar to experiential trauma. When somebody experiences some sort of trauma in their life, it activates their HPA axis, or the threat response system. You know, this is what we're talking about with PTSD and cptsd. Addiction does the same thing. Alterations in neurochemicals from the addictive behaviors trigger the fight or flight response or that HPA axis, either during use, if they're using stimulants, or during withdrawal, if they're using depressants. When the depressants leave their system, there is a flood of excitatory neurochemicals. So we're triggering that threat response system. We're triggering that HPA axis in the body. Persistent triggering of this system results in alterations to protect the organism. And I call this the Flat and the Furious. Because when the system is activated too much, then it starts only reacting. You know, it starts paring down it's its excitability or its sensitivity, and it only reacts when there's a huge threat to what's going on. So the person may feel flat, they're not feeling much of anything. But then when they do get triggered, oh boy, do they get triggered. So they go from flat to furious. It's important. Again, and I know I've said this like three times, but it's so important for you to recognize that addiction, whether it is a behavioral addiction like porn addiction or chemical addiction, any of those addictions that flood the system with excitatory neurochemicals, any of those behaviors that cause the fight or flight axis or the HPA axis to be triggered, are going to result in brain changes similar to that as people who have, for example, PTSD or cptsd. My philosophy or my definitions, I guess, are that the causes of addiction are neurochemical changes and the organism's desire to rebalance or to accommodate or compensate for those neurochemical changes. But there are precipitants and risk factors for addiction, especially for people who've experienced trauma. Physical precipitance or risk factors. Pain. Whether it is due to injury as a result of substance use or injury as a result of an accident, chronic pain can be a risk factor for the development of substance abuse. Pain from autoimmune issues can also be a risk factor. When you're in pain all the time, it's exhausting, and a lot of people want to quell that pain. Now, I'm not saying that taking pain medication as prescribed is an addiction. Remember the qualifying phrase, continued use despite negative consequences. It's when you are misusing medications that it becomes a problem. And pain can also occur from withdrawal. If somebody is abusing opioids, they quit taking opioids. Then their pain threshold is way low because their body's not producing the natural painkillers. So they're going to feel more pain and they may self medicate by using again. Insufficient sleep can also be a risk factor for addiction. People who've experienced trauma often don't sleep well because they are hypervigilant, because they have difficulty relaxing, because they don't feel safe, so they may not get good sleep. Well, what happens when we don't get good sleep? A lot of times we self medicate with stimulants. And some people may look towards harder stimulants when their body develops a tolerance to things like caffeine use. If you are using substances, then when you're using stimulants, for example, that's going to impair your sleep. If you're using depressants, it May help you get to sleep faster. But the quality of sleep is often crappy. And as those depressants leave your system, your sleep is disrupted even more. Poor nutrition can also be a risk factor. And disrupted circadian rhythms, from staying up all night playing video games or staying up all night using, or being hyper vigilant and not able to get quality sleep as a result of trauma can disrupt the hormones that help us feel hungry or satiated. So people may not remember to eat. They may not be motivated to eat, or they may eat constantly, but they may eat to soothe. They may eat high fat, high processed foods in order to trigger the release of dopamine and serotonin. And some people have their appetite suppressed by addiction. When they use their substance, it has an appetite suppressant effect. So they're not getting good nutrition, so their body can't make the building blocks to rebalance itself and recover from the use episode a dysregulated HPA axis. And that's what I was talking about with the Flat and the Furious earlier. When people experience trauma, either as a result of using substances or a result of an experience, it can lead to a aspect HPA axis or a threat response system that is dysregulated. When people are feeling flat, they may use in order to try to feel better or feel something. When people are feeling furious, they may use to numb the pain, to quell the anxiety or the anger. Impulse control issues, including ADHD, is also a risk factor for addiction. And some people who've experienced trauma may have some impulse control issues because of that dysregulated HPA axis. They may, when they start feeling anxious or angry, they go from 0 to 250 like that, and it's overwhelming and they, they don't know how to make it stop. So they turn to the addiction. People with ADHD, we also know, tend to be more impulsive. They tend to be more at risk for acting before they think. And there is a risk in the literature associated or a higher risk for people with ADHD for developing addictions and early direct exposure to substances. The brain before the age of about 24 is still forming, especially in the area of the prefrontal cortex, which is where we have our impulse control and our higher order thinking and our decision making centers. And they found that when people are exposed to trauma or substances at an early age, before the brain is finished forming, that it actually causes a lot more damage. And it causes damage a lot easier than for somebody who is older. So think about a clay pot when you've just finished making the pot before it's been put in the kiln to bake, harden, whatever you call it, it's very easy to injure or to cause problems to that vase. That's the way our brain is before it solidifies or finishes developing at age 24ish. Once we reach maturity, once our brain is finally matured, it's kind of like taking that vase and getting it out of the kiln. Can it be, can it be injured or broken? Yes, it can. You know, you can drop a vase and break it. However, a simple assault like poking it with your finger isn't going to be as likely to cause as much damage. That's not advocating for use after the age of 24, but it's just pointing out that people who've experienced trauma again as a result of an experience or even use, whether it's use of porn or substances or whatever it is, their brain actually was more significantly injured, most likely from that event or those events than it would have been had they been over the age of 25. Affective risk factors and I could have a list of all of the distressful emotions. But one of the reasons reasons people use is to escape from pain. And it could be anger, anxiety, depression, guilt, any of those things. A lot of times substances help numb a feeling or help them feel something else. If they're feeling depressed and they abuse a stimulant or something that will produce euphoria, then they're artificially creating that sensation. Sometimes boredom will prompt people to use and we want to look at what is causing the boredom. Is it because when they're not doing something, when they have to sit still, then they're with their own thoughts and they can't tolerate those thoughts because they are too overwhelming. Or is it that they have, maybe they're gifted or they have ADHD and they have a need to be engaged more, or maybe they need more structure. So there's a lot of different reasons for boredom. But distressful emotions we know can be a risk factor, especially if the person does not have adequate tools to tolerate the distress, adequate distress tolerance skills or, and, or to cope with the problem. Emotional dysregulation is that flat to furious. It's when somebody experiences an emotion that is significantly more intense than what other people may experience it as. But when you experience an overwhelming emotion, it can make the person feel scared and powerless within their own body. And this emotional dysregulation or often leads to rejection from other people, criticism being dismissed. People aren't there helping Saying, wow, that must be overpowering. Let's figure out how to deal with it. They're saying, oh, you're overreacting, get over it. So the person is left feeling vulnerable and disempowered and they may turn to the one thing that they know will actually numb that or, or turn down the volume of that emotion. Some cognitively, a lack of coping skills is a risk factor because when we experience distress, if we don't know how to problem solve, if we don't know how to deal with it, then we may feel stuck. So one alternative that sometimes happens is people choose to use negative attitudes like hopelessness, helplessness and powerlessness. If somebody has been exposed to trauma, they may have learned from an early age, or as a result of that trauma, they may have developed the belief that they are powerless and unsafe in the world. And so they perceive, they look at the world, they see the world through that lens, through that film of hopelessness, helplessness and powerlessness. So they perceive things as threatening, they see the threats, they don't see the positive things, they perceive things as dangerous, they assume things are dangerous even if they don't know they are. A lot of times when people have a negative attitude, they, they start operating from an emotion based reasoning point of view. So if they feel angry, then they figure there must be a reason that they're angry and they look for whatever that reason is. They may have an overly powerful default mode network. And what the DMN is, is basically our autopilot. When you are doing things like, you know, getting up and going to work, maybe you drive to work and do you really think about every single turn you've got to make or do you do it kind of on autopilot and that's your default mode network? It is what helps you get through life when you're doing things that you've done a bunch of times before. So it says, you know what, you don't need to worry about thinking about this right now, I'll take care of it. So your body is sort of on autopilot. Unfortunately, when people experience trauma, their default mode network is one that anticipates threat. It anticipates danger in the environment, and so it keeps anxiety ramped up. When people experience trauma, their amygdala, which is where we have the fear processing part, one of the fear processing centers in our brain, it actually forms stronger connections with that default mode network, which intensifies the focus on the threat and the danger. This is our body's way of saying, hey, you need to be aware because we don't want to go there again. We don't want to experience another trauma. But unfortunately that they found that in people who have an overly powerful default mode network, it's harder for them to disengage that and engage what we call the executive control network, or that higher order thinking that can say, okay, I feel anxious, but is there a reason to be anxious? So it's harder for them to get into their wise mind. As Linehan would say, Fetal alcohol spectrum disorders can make people more at risk for trauma as well as for addiction. People with fetal alcohol spectrum disorders have difficulty interpreting nonverbals and are often very gullible. They are very. They don't learn from their mistakes and they often have difficulty anticipating consequences. So they can be manipulated by bad actors very easily, which means they are at much higher risk for trauma because bad actors don't care whether the. Whether the person has negative consequences. Likewise, people with FASDs are more easily manipulated into using and more easily manipulated by peer pressure. Therefore, they may engage in heavier, more consistent substance use or addictive behaviors in response to their peers and to their environment, which can cause them to start developing tolerance and those physiological changes. And finally, obsessive compulsive disorder is highly correlated with addiction. In obsessive compulsive disorders, People have obsessions about things that cause them anxiety, cause them distress, and they have these compulsions, if I do this, it will quell the anxiety and the distress. Well, one of those things sometimes can become using. And we see a similar pattern. It's not the same, but we do see a similar pattern in addictions where when people start having these obsessions about needing to use, they can't get the addiction off of their mind. When they use, all of a sudden it quiets that voice for a few minutes and it helps them relax. Environmentally, access is a risk for addiction. And what I mean by that is, if people have easy access to substances or to pornography or to video games or whatever it is, then it is a risk factor, Especially if they've experienced trauma. If they've got PTSD or hypervigilance, that they may be seeking to find a way to self medicate, then having that access there may pose a temptation. The unsafe environment also can be a risk factor for addiction if it doesn't meet their physical needs. That's traumatizing physiologically. When we don't get our needs met, the body goes into a state of fight or flee. But when we don't get our physical needs met, it makes us feel unsafe and disempowered. That's trauma affective. If it's an unsafe affective environment, it's not safe to have your feelings. If you're in an environment and when you start to have feelings, nobody helps you learn how to deal with them. Kids don't know how to deal with their feelings. That's what they're supposed to learn in their relationship with their caregivers and safety. When people feel unsafe in their environment, if they're worried about somebody breaking in, or maybe they're sleeping in their car or they're sleeping on the street, that is traumatic. They are not going to get good sleep. Their threat response system is going to be ramped up because their body's saying, okay, you may doze off, but it's not safe to get that deep quality sleep that you need. And all of these can start causing systemic and brain changes. And if people aren't getting their relationship needs met, an unsafe environment can also be one where the people in it are not safe. The people in it are aggressive or abusive or neglectful. Other risk factors Low self esteem. When people don't feel good about themselves, a lot of times it's kind of like having an abusive person within their own head. That negative inner voice can be so critical and so loud that substance use may be one way of trying to numb it or quiet that voice. People who've experienced trauma often have difficulties with self esteem because of their sense of being broken or damaged in some way. People with personality disorders and conduct and oppositional defiant disorders, I'm going to clump these together because most of the time with these disorders, when you look at the symptoms, it makes sense. The symptoms are often of these disorders are often a way that the person developed in order to try to survive trauma. When we look at people with personality disorders and conduct disorder or oppositional defiant disorder, a lot of times we find find a history of trauma. Addiction may develop as a way to try to help them survive. Feeling unloved, feeling unsafe, feeling disempowered, insecure attachment and abandonment Anxiety is extremely common in people with addictions and it can promote addiction. A lot of times when children experience trauma, adverse childhood experiences cause trauma. And those adverse childhood experiences can kind of be generally categorized as abuse or neglect. Having a caregiver that had a mental health or substance use issue so they were emotionally or physically unavailable or unsafe and abandonment. Children who've experienced this don't develop secure attachment. Secure attachment is vital to helping children learn how to identify their emotions. How to tolerate their emotions, and how to cope with their emotions. Secure attachments are vital to helping children learn that they are lovable, that they deserve to be cared for, and that it's okay to take care of themselves. Children who've experienced adverse childhood experiences or childhood trauma are at higher risk for addiction Because a lot of times their HPA axis, remember that threat response system has already long been dysregulated from the trauma. And the addiction may be a way of trying to rebalance the system the only way they know how. Abusive relationships and peer pressure also can contribute to feelings of hopelessness and helplessness and contribute to misuse of substances or activities. The functions of addiction. Well, it's pretty simple to produce feelings of pleasure, euphoria, or happiness when none exists by altering brain chemicals. If somebody just can't feel happy, sometimes they're just like, please let me see color, let me feel something. It can be used to numb emotional or physical pain when nothing else works. And again, this is by altering brain chemicals. And they can be used to help the person survive when the person can't tolerate the pain and they feel overwhelmed, hopeless and helpless. In the 25 some odd years that I've worked with people with addictions, and I grew up in a family where people had addictions, I have yet to to find somebody who wasn't trying to survive. The addiction was not a choice. The substance use. They chose to start using substances or engaging in that behavior because they wanted to survive. Then their body underwent all these changes. Remember, addiction is no more of a choice than diabetes or hypertension or. Or cardiovascular disease. So they developed this disease as a result of starting to use, but they started to use because they didn't know how to go on. Addiction develops over time as a result of brain changes. I know I've said that a bunch of times, but it's so important to me that as clinicians, we understand this and communicate it to people. It is not just a choice. It is not just a behavior. Addiction is not a choice. Addiction is a dysfunction in our body systems, in our physiological system. Physiological systems, sorry. Addiction develops over time as a result of increasing stress, problems, depression or anxiety. Remember, progressive, incurable and fatal. Not only is the dysfunction in the body system progressive for the person, but also all those other issues, like the relationship problems that are occurring because of the addiction or the financial problems or whatever else, those continue to progress as well. And when the person sobers up, they look around and they see this swath of destruction and it is completely overwhelming. And what do you think their response is because they don't have any other tools to deal with it? They don't have tools in their toolbox, or they don't know how to use them even if they're there? Recovery involves identifying and eliminating activities and behaviors that are keeping the brain chemicals out of balance. This includes crappy nutrition. This includes not getting adequate sleep. This includes making sure the person stabilizes their circadian rhythms. When I worked in residential facilities, one of the things that was really important was the schedule. Even if people had a difficult time participating, it was important that they got up and showed up, because that helped start resetting their circadian rhythms to a balanced place. Recovery also involves developing effective ways to deal with what has been to date, unmanageable and developing tools that include patience, compassion, and determination. Addiction almost never occurs without depression, anxiety, anger, guilt, grief, and a whole host of other things. We can't just say, let's get rid of the addiction, let's detox the person, and then everything will be hunky dory. No, detoxing is the first place, first step, because we gotta get the body to a place where it can even start rebuilding and recovering. It's like after a flood. You're not gonna start repainting the walls while there's still six inches of water coming up the drywall. No, you're gonna have to wait until all that water's out of the house before you start repairing it. Okay. But it's also important to recognize that just like when there's a flood, the drywall may get damaged, the carpet's damaged, the flooring's damaged, you may start having mildew grow. There are a lot of other issues that occur concurrently, and that mildew may have been there before the flood, and the flood just helped it all of a sudden start flourishing. Just like depression may have been there before the addiction, but. But the addictive behaviors actually throw the neurotransmitters even further out of balance. So it makes that depression flourish even more. We want to recognize that co occurring disorders are the expectation, not the exception. We have to treat whatever was causing that distress. We have to help the person develop the tools to deal with the stress when it comes along. Clinically significant anxiety or depression also rarely occurs without the presence of some addictive behaviors. And I really challenge you to find people who have clinically significant diagnosable depression or anxiety, and how many of them don't have some sort of addictive response. And unfortunately, a lot of them do. Whether it's smoking or drinking, or working. Working can be another thing where somebody just throws themselves into something that will occupy their mind and potentially provide them a sense of accomplishment and therefore pleasure. Addictive behaviors are an ineffective way of coping and and almost always cause more behaviors in the long run or more problems in the long run. Effective addiction treatment has to focus on identifying and addressing the causes of the pain. For the individual, it's more than just repairing the body. We have to look back and say, where did this come from? What issues are maintaining your depression, your anxiety, your grief, your your feelings of hopelessness, helplessness and powerlessness. Stopping use is not the same as recovery. Recovery is creating a lifestyle in which you feel happy more often than not. You are physically comfortable most of the time and you do not need to escape or numb physical or emotional pain. You're able to actually sit with it. You don't like it, but you can sit with it for a minute until you can figure out how to address it. To become an addiction counselor, you need to get 180 to about 365 hours of addiction specific training, complete an internship and pass a state exam. Allceus.com offers an online. To become an addiction counselor, you must get between 180 and 365 hours of addiction specific training, complete an internship and pass a state exam. The number of hours really depends on your state. One of the interesting things about becoming an addiction counselor is in many states people can do this without having to get a master's degree. So it opens this profession up to a lot of people who would otherwise maybe not be able to or want to go through all that schooling. Allceus.com offers an online self paced multimedia curriculum that meets the academic training requirements for most state addiction professional boards. You can find out more@allce.com certificate tracks if you're studying for your state boards, you've already gotten all your training. Check out the Addiction Counselor Exam review playlist@allceus.com YouTube playlists. Executive Producer for this episode is Hype Media Global Technical Producer Mr. Charles Snipes Host Dr. Donnelly Snipes this episode was filmed on January 12, 2022.