Tuesday, December 17, 2013

addiction and biology

What do you think, from a professional standpoint, of the suggestion that alcoholism is not a biological proclivity (as it is popularly portrayed) but rather a character flaw? If it were a biological matter, how would anyone be able to stop?

What a timely question.  I have quite a few clients struggling with addiction right now (not that we aren't all struggling addicts to some degree).  They have different proclivities (food, gambling, alcohol, work) but they what they all have in common is that they are in search of a fix for hard-to-deal-with feelings and get hooked on what works for them. 

You need two things, as far as I can tell, for an addiction to develop: a problem and a short-term solution that fixes it.  We are all prone to the former (some more prone than others, depending on biology, psychology, up-bringing and, of course, stress).  The solution depends on all of the above, but there is certainly a strong link to biology.  Chemistry regulates our emotions, and vice versa.  Some chemicals even regulate our choice of addiction.  Did you know that people who take L-DOPA, i.e. for Parkinson's, tend to develop gambling addictions?

How is anyone able to stop?  Some stop and it’s no big deal.  Some have to struggle like hell against their “proclivity”. 

I think this too is largely determined by biology.  Some people are born addicted to their mother’s habits.  That is no “character flaw”.  It seems to me that the only way to quit an addiction is to go against the grain of what you want to do on a more impulsive level, for whatever reason you’re doing it, and stop and do something else instead, even if this initially means, as I think it does for many people, doing nothing at all, feeling the urge and letting it pass.

The key, for many, is to have a goal, something that motivates you to look beyond the immediate and short-term fix, sometimes it's a matter of one biological urge dominating another.

Is a successful quit the result of strength of character, timing, luck or biology, divine intervention or allowing the Divine to intervene on our behalf, or a chicken-egg thing?  I would have to say "yes" to all of the above :)

Sunday, November 3, 2013

Don't advise and explain

The other day I witnessed a painful dialogue between a husband and wife.  

The woman was telling her husband about how she “loses” it with her nine year-old son, John.  He pushes all her buttons at the worst times, she explained, like in the morning when she is pressed to get out the door and he refuses to get dressed or turn off the TV, whines and is altogether oppositional.  She tries and tries to reason with him but, at one point, she begins to feel like he is making zero effort, feels taunted and flustered and then-finally- “loses it” on him.  She begins to scream and threaten him with consequences.  Once she even hit him.  
At this point, the woman began to sob.  She told her husband how ashamed she was of being unable to control her emotional reactions and how guilty she felt for hurting their son.  She knew it was both useless and wrong to yell at him in these situations but she felt helpless to do otherwise.

Her husband, who until then had been listening empathically to his wife, cleared his throat and started to speak:

“Dear, you really just need to learn how to control your temper.  Step out of the situation, relax and tell yourself to calm down so you can deal with John more rationally.  I know you can do it.  You really just need to learn anger management.  Here, dry up those tears.”

He handed her a kleenex and then went on to explain to her a step-by-step plan for how she should deal with their son.  His wife looked over at me, her face hardened and her lips pursed angrily.  

“Is there something you want to say with that look?” I asked her, “Something you are asking me to say?”

“I know he means well,” she said, “But I am really hating him right now.”

I nodded.

When someone is expressing their feelings to us, one of the first things we all need to learn is how not to do anything and just listen, or mirror back.  All too often we feel the urge to respond, explain, justify, advise or apologize, i.e. offer the person something that hasn’t been asked for.  This has a tendency to frustrate the person who may feel like they have not been heard, or that they are being goaded into doing something they are not ready to do.  It is more often met with resistance or anger rather than gratitude.

The motivation to do something about a problem is an organic process; it usually arises naturally when just given space.

So give it space.

Saturday, October 12, 2013

No (Red) Bull!

I just finished meeting with a young woman, Katie, whom I have known for about seven years, and whom I first met at the child/adolescent out-patient clinic of the Charles Le Moyne Hospital.  She had been evaluated by Dr. Jean-Pierre Bienvenu and diagnosed with Juvenile Bipolar Disorder as well as the highly unusual Intermittent Explosive Disorder related to alcohol consumption.

In the seven years that I have known her, Katie has suffered tremendous anxiety and tortuously obsessive thoughts for which various medications have been prescribed to help get these debilitating symptoms under control.  The medications, usually some variation on the standard prescription of long-acting anti-depressants in combination with short-acting ant-anxiety pills, provided little relief.

Until recently.

A few months ago, Katie ended up at the hospital one evening after having had a few too many drinks in combination with a joint.  She was on the verge of hysterics and her boyfriend, seeing his girlfriend so completely transformed, insisted they go to the emergency room.

Katie was evaluated by a nurse who took stock of everything Katie had consumed on top of her prescriptions over the past years, then told Katie, “You might have died”.

It turns out Katie had been consuming the energy drink Red Bull on a daily basis for eight years, since before her initial consultation with the psychiatrist at Charles Le Moyne.  Over the past few years, on top of her prescription drugs, she'd added a daily joint or two because of incessant jitters.  Now and then, she would also have a few drinks on top of that combination.  Every time she did so, she would have an “episode” where her heart would beat excessively fast and she would become “another person”, doing things that were reported to her later that she was never able to recall.  She would experience profound distress after these humiliating episodes, and her anxiety would be full-blown and debilitating for several days.  

While the doctor who initially evaluated Katie hadn't taken a complete history, misdiagnosed the source of her episodes and prescribed something that made her anxiety worse, the nurse took the time to find out everything Katie was putting into her system and told Katie that Red Bull was like taking speed and that she probably started using marijuana regularly to help counteract the effects.  Katie's psychiatric diagnoses may not have been accurate and her prescription drugs may not have even been necessary.  Certainly the drug and alcohol combinations were very dangerous for her heart, the nurse told her, and Katie's hormone and serotonin levels were probably seriously out of whack.  She said that Katie had to stop mixing Red Bull and drugs immediately or she may die.  So she did.

Katie quit Red Bull and marijuana that day but continued to drink alcohol occasionally.  She has not had an “episode” since, and she is calmer, more serene, and happier than I have ever seen her.

There are obviously psychoactive ingredients in these over-the-counter energy drinks that not only accelerate the heart and trigger anxiety but, in combination with other drugs (prescription or street drugs) and alcohol, are apparently very very harmful.

Consumer beware!  Consult a health professional who takes the time to do a full medical examination and history before prescribing anything to you.

Sunday, September 15, 2013

after the affair

[Note to readers: all published exchanges are edited to remove any identifying information about the querent.]

My wife and I separated because I had an affair.  Although I ended the affair as soon as she found out, my wife started seeing someone else as soon as we separated.

Now we both want to get back together.  I’m really happy about that, but my wife says she needs time to end her relationship with this new guy.  I want to give her the time she needs but the thing is: I can’t stop looking up her activities on Facebook, and I’m jealous, especially when I see her online at the same time he is, after she’s just told me she’s going to bed.  She isn’t.  She’s chatting with him!  We were making progress there for a while but now it seems to me like she has no real intention of stopping the relationship she has with this person.

I'm finding it really hard to deal with this situation and I wanted to get your opinion on how I can effectively set boundaries without it coming off as being inconsiderate or mean from my end.  

I feel as if I should just ask her what their status is and whether she has told him that she is strongly or seriously working things out between us.  Or maybe I should give her time to do it on her own without my mentioning it and seeming jealous. What do you think? 

I can understand your distress!

The first thing I would advise you is: tell her how you feel.  By this I mean, not your observations or judgments of her, but your loving feelings for her, i.e. "I really care about you, I am not interested in any other woman and I want to be with you again".  Do not "confront" her about her stuff in a way that is harsh or judgmental.  She is probably scared about putting all her eggs in one basket with you again.

The second thing I would do is tell her that you cannot work on your relationship with her if she is seeing someone else, and that, if she is with you on going forward as a couple, you need to be exclusive and absolutely transparent with each other.  You will both have a lot of work to do to regain each other’s trust, and to do this you need to close the "exits” that you have used to escape intimacy.

Finally, and this may be the hardest thing for you to grasp (as it is for all of us when we find ourselves in situations beyond our control): setting boundaries is something you do on your own turf, not on hers.  The only person you can control is yourself.  You cannot tell her what to do or change her behavior, but you CAN change yours.  So, if it bothers you that she is on FB after having told you she is going to bed, then you should tell her that you cannot have a relationship based on deception and that you are withdrawing from the relationship until she ends it with the other guy.  You don’t need her to do anything, but you do need to act on your own sense of violated boundaries.  She will then have to decide if her relationship to you is important enough to change herself.

Hope that helps!

Saturday, August 3, 2013

did I cheat?

[Note to readers: all published exchanges are edited to remove any identifying information about the querent.]


When I was dating my last boyfriend, our relationship came to a standstill.  We talked, and he suggested we take a time-out to think about it.  My boyfriend seemed hesitant about continuing with me and, although we hadn’t had sex in a while and the relationship was at best lukewarm, I found his suggestion insulting.  It was like he was breaking up with me but wanting to keep me on the back burner in case he couldn’t find anyone else.  It really pissed me off. 

A few days later, I went out with the girls.  I had a few drinks and realized that I had no more feelings for my boyfriend.  He’d hurt me, I’d lost respect for him, and it was over.  I made out with a guy I met at the bar.  It was nice to feel like someone was into me.  What a difference from my ex!

When he (my ex) eventually called after a couple of weeks, he suggested we remain friends, and I happily agreed.  I told him that, in a way, I was relieved because I knew he had already withdrawn from “us” and that we’d reached a point of no-return.  I told him that making out with someone else brought this home to me even more.  We could both do better.

Well, to my surprise, he was really offended.  He accused me of “cheating”! I didn't think I was cheating until he said that, and now I am second-guessing myself.  

Can you cheat on someone if, in your own mind, the relationship is over?  (I think you wrote somewhere that having an affair was indicative of a marital breakdown.  That’s exactly how I saw it, like our relationship was breaking down and my boyfriend was ditching me, and that I had every reason to try with someone else).

But, objectively speaking, on the basis of facts, is my situation “cheating”?

Great question!

The way I see it is like this: betrayal is a subjective experience that cannot always be determined on the basis of facts alone.

If you've made an explicit promise to someone and then broken it, that would be objectively verifiable.  But most betrayals occur due to breaking implicit agreements and promises, and these are not so readily verified.

There are two different points of view to consider.  Yours and your ex-boyfriend's.

From your own point of view, as you said, you had "no more feelings” for your boyfriend so- for you- the relationship was over and, technically, you cannot betray a relationship that doesn't exist.

But there is also your boyfriend's point of view: was the relationship over for him, or was he still in it but just "thinking about it"?  If so, he was betrayed, whether you intended to betray him or not, just as you presumably felt betrayed by his unilaterally calling a time-out.

The truth is: when it comes to subjective experiences- one event experienced by two different people- there is no one truth.  There are at least two.  And, if we are ambivalent or confused, there may be even more.

re: what I said about affairs- a person may have a “reason” to want to look outside the marriage for satisfaction, but a reason does not make an affair less of a betrayal, unless of course your partner has already betrayed a promise, even an implicit one (for example, by abandoning you), which is in fact another way of exiting the relationship.

My advice: don't get hooked into trying to determine whether you were right or wrong according to some objective standard about “what cheating is”.  If you want to know the truth, consider everyone’s perspective.  Find out whether and how someone felt betrayed, and the part- if any- you or he played in that, whether intentionally or not.  That, in my opinion, is as close to the truth as you can get.