“Spirituality”—like “love”—has many interpretations.  Some identify spirituality as their personal sense of connection, meaning, and purpose.  Others identify it is an elusive abstraction they have never experienced. Those who equate spirituality with religion and are not religious themselves may assume spirituality is not relevant to them.  But when spirituality is understood as pertaining to all relationships—with self, with other human beings, and with the rest of the universe including nature and any personal sense of God or higher power—then the concept encompasses much more than religion and is unavoidably relevant to everyone.  Special moments with family, pets, sunsets, trees, rocks, music, or sports teams, for example, become identifiable as spiritual experiences. Scientific research as well as personal experience demonstrates that interpersonal relationships may be helpful, harmful, or a combination of the two.  In a similar way, spiritual connections may be positive, negative, or some of each.  At a particular moment, for...

Addiction damages what matters most.  Body, family, career, and citizenship are frequent casualties of the compulsive use of alcohol and other drugs.  How human behavior becomes so self-defeating and how affected individuals change for the better has been described from many perspectives.  Two sources we might expect to have differing views about recovery actually illumine the same path. Science and spirituality both point to positive interpersonal relationships as treatment for addiction.  Many therapeutic factors contribute to recovery, but healthy human connections are fundamental.  This Addiction Medicine Update presents a scientific point of view; the next Update, a spiritual one.  Neurobiology of Addiction Lower centers of the central nervous system (limbic system, brain stem, and spinal cord) give rise to a great deal of human behavior, and these lower centers routinely function independently of higher centers (cerebral cortex).  Simple behaviors that don’t require conscious thought include reflexes, breathing, and body language.  More...

An estimated 8.9 million Americans live at the severe end of the spectrum of alcohol use disorders.  Regardless of terminology – alcohol addiction, alcohol dependence, or moderate to severe alcohol use disorder – these individuals satisfy diagnostic criteria for a potentially fatal chronic disease characterized by high post-treatment recidivism.  The human and dollar costs of this situation are enormous and touch everyone; yet the magnitude of our collective response fails to match the magnitude of the problem. For example, practical experience backed by brain science identifies two basic actions as essential to recovery; yet individuals with the disease repeatedly fail to adopt them.  Research demonstrates that recovery rates are highest when addiction treatment that monitors abstinence is continuous; yet healthcare providers fail to organize for this and for the most part still treat alcohol addiction in discrete episodes.  The FDA has approved three medications for the treatment of alcohol addiction; yet less...

With November comes the holiday season. In that spirit, we are reprinting the Addiction Medicine Update, Hope & Caution – for Happy Holidays, originally published in November 2012.  As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all.  Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such as shopping, travel, cooking, social gatherings, and so forth—or the stress of not having any of those to...

It is difficult to open any news medium, whether the local Denver free newspaper or CNN, without encountering an analysis of marijuana policy.  Similar to the division of Americans into politically outspoken reds and blues, passionate factions that either support or oppose wider access to marijuana can be found throughout the nation.  In many states, marijuana policies are now changed because supporters’ influence led to legislative action.  Even though marijuana remains an illegal drug by federal law, several states have passed their own laws saying marijuana is legal for medical treatment and/or recreation.  Legalization of marijuana was discussed in this space last year.  This Update will focus on “medical marijuana.” “Marijuana” designates a group of herbal or plant products—not a single chemical substance—that derive from strains of Cannabis sativa and Cannabis indica.  The specific chemicals in different samples of marijuana and their relative proportions vary with the origin of the samples.  In...

People who are close to individuals with active addiction sometimes have to make high-stakes decisions.  Desperate situations compel them to act, and then leave them hoping and praying for a positive outcome.  Parents’ decisions may be the toughest, regardless of the age of their child.  “Will giving support right now save my child—or be enabling and ultimately destructive?”  “Will withholding support right now save my child—or precipitate disaster?” At such times it can be prudent to avoid all-or-nothing responses in favor of a sequence of limits and consequences.  That way success or failure is not determined all at once.  Success—safe recovery—then depends upon all concerned continuously making adjustments to maintain balance between clear-cut expectations and consequences. Establishing and maintaining balance may also help this country work through the larger crisis of opioid misuse, opioid addiction, and overdose deaths.  This crisis began with a rapid rise in opioid misuse in the late...

In addition to their literal definitions, the words we use can invoke powerful ideas and feelings.  The extended cognitive and emotional meanings of words are their connotations.  Words, particularly their connotations, help shape sense of self and expectations, which makes it important to choose words carefully when characterizing others and ourselves.  Affirmations enrich sense of self and set favorable expectations.  Pejorative language and labels, on the other hand, feed stigma and generate harmful self-fulfilling prophecies.   A therapist noticed that many of her patients were in the habit of saying “I’m sorry” when they had done nothing wrong.  This troubled her because contrition is appropriate only when you have something to be contrite about.  The therapist realized all the unnecessary sorry-statements were unhealthy because they added to her patients’ shame and overinflated feelings of responsibility.  She now urges patients to permanently drop “I’m sorry” from their vocabulary and replace that statement...

April is NCADD Alcohol Awareness Month and we are reprinting the Addiction Medicine Update, Preventing Alcohol Problems, published last year as the second of a three-part series on prevention.  The harmful use of alcohol is the third leading risk factor for poor health worldwide and the estimated costs of alcohol abuse in the United States, which encompass lost productivity as well as medical problems, top $220 billion per year.  There’s a lot to be done.  Fortunately, a lot is being done.  April is Alcohol Awareness Month, a fitting time to acknowledge creative and effective prevention approaches that are reducing risk now—we’ve come a long way from the ineffective and sometimes harmful information-only scare tactics of the 1950s and 1960s. Preventive interventions target the population at large (universal), persons at increased risk (selective), or persons with prodromal symptoms (indicated). Depending upon the characteristics of a particular person, existing programs might influence that...

Ever wonder why so many of us lose our voice precisely at the moment we need to ask for help?  Credit shame, the pivotal emotion that drives self-defeating behavior, together with all-or-nothing thinking, our most common cognitive distortion. “Shame,” much like “stress,” means different things to different people.  Here, shame refers to our ongoing sense that we are imperfect.  Our sense of an imperfect self can, however, serve us well—provided we accept it and are open about it with other human beings.  Then it generates empathy and positive spiritual connections.  But all too often shame is toxic; we are convinced we are less than, unworthy—that we deserve to be rejected.  We automatically believe that, at all costs, we must not reveal our true selves.  We fear that if we do, other people will want nothing to do with us. We all have a personal burden of shame that is toxic.  Shame...

Educators and clinicians have long recognized that children and youth with social, emotional, and learning problems often experience neglect and abuse in earlier years.  Research now shows that harm associated with traumatic childhood experiences does not end when young people grow up. In the Adverse Childhood Experiences Study (ACE Study) investigators from the Kaiser Permanente Health Appraisal Clinic in San Diego and the Centers for Disease Control and Prevention examined the impact of mistreatment in childhood on well-being in adult life by monitoring the health of a cohort of men and women who, in the course of comprehensive medical assessments during 1995 to 1997, answered questions about trauma during childhood.  The questions were embedded in a Family Health History questionnaire and elicited information on ten types of adverse childhood experiences (ACEs).  Five of the experiences reflect family dysfunction (household member substance abuse, mental illness, or incarceration; parental separation or divorce; mother...