Information Program on Addiction

Conversation Cafe spent 6 months researching and discussing the addiction opioid epidemic sweeping our area, particularly concerned with its effects on youth. After a working group put together the main information points, we are shared this information over the reflective time of Lent each of the 6 weeks in our bulletin. This is a wilderness journey for many young folks in our area, and before we can help, we must understand with a lens of love.


 Here is what we learned about:

Week 1: The Current Situation

  • The increase in prescriptions of opioid pain relievers has been accompanied by dramatic increases in misuse and by a more than 200% increase in emergency departments visits from 2005-2011.

  • In  2014, 47,055 drug overdose deaths occurred in the United States, and 61% were the result of opioid use

  • Opioid deaths in NJ have increased by 213% between 2005 and 2015, according to the New Jersey Attorney General’s Office.

  • No surprise here: addiction is difficult to define! According to the American Psychiatric Association, it is best described as “compulsive use of a substance or compulsive engagement in a behavior despite ongoing negative consequences.”

  • If the definition of addiction includes ongoing behavior despite negative consequences, then punishment and criminalization are not effective responses to addiction!

 

Week 2: How the Brain Works

  • Brain complexity is highlighted by multi-faceted development based on many, many variables: genetics (which can be influenced depending on stress/trauma of parent, or even grandparent), timing for information input and impulse control at particular stages of life, overall sensitivity to the world, social interaction, self-awareness, and even existential understanding. As a result, each brain’s reliance on addiction, and each brain’s needs in response to its addiction, is highly individualized.

  • The addiction cycle, according to the 2016 Surgeon General’s Report, follows the below pattern: 1) Binge/Intoxication, where an individual consumes an intoxicating substance and experiences rewarding effect. 2) Withdrawal/Negative Affect, where an individual experiences a negative emotional state in absence of the substance 3) Preoccupation/Anticipation, where an individual seeks substances again after a period of abstinence.

  • Addiction also forms like other habits in the brain. Duhigg, in The Power of Habit, talks about habit formation in a three-step loop. 1) cue, a trigger that tells your brain to go into automatic mode and which habit to use 2) routine/behavior, which can be physical or mental or emotional 3) reward, which helps your brain figure out if this loop is worth remembering for the future. The more we engage in this loop over a particular habit, the more automatic it becomes. This dependence on habit is necessary, even helpful, for viable functioning, as well as dangerous.

  • The parts of our brain that tend toward addiction also serve love and ambition - that is, loving and striving follow the same pattern as addiction. For example, when we love a child, we continue to care for it despite ongoing negative consequences, such as lack of sleep and other bodily neglect. When we pursue a particular goal, such as a promotion at work, we may work longer hours despite the negative consequence of less time with family and/or friends. In many instances, those predisposed toward addiction also have a higher inclination towards being driven and loving.

 

Week 3: Adolescent Emotional Life

  • As young as preschool, children fixate on ideas of “goodness” and “badness” as they relate to themselves and tend to see the world in stark extremes of black and white. These initial self-concepts shape their choices, and in turn, their brains.

  • Most cases of addiction start long before affected youth are ever exposed to drugs. Exposure to drugs is not the differentiating factor in addiction - that is, a person could be exposed to drugs and not become addicted. Mindset is a much bigger factor.

  • Carol Dweck in her book Mindsets, explains the difference between two mindsets. The fixed or “entity” mindset says that we are born “good” or “bad” and will stay that way. The growth or “incremental” mindset says that we are malleable and can improve with effort. A fixed mindset creates an urgency to prove yourself over and over. A growth mindset is based on the belief that your qualities are things you can cultivate through your efforts, that you can grow and change through application and experience.

  • Adolescent emotional life is often driven by social success and stress. Emotion powers learning. Teen years are a time of extreme vulnerability in this respect. Puberty is when youth begin to clearly delineate status hierarchies, and the social status stress can be a critical determinant of health (including addiction, obesity, and disease).

  • Adolescents who cannot self-regulate well - whether because of ADHD, trauma, autism, mood, or personality disorders - are more often subjected to bullying and social rejection, adding severe social stress. Addiction can be learned as bullies confirm children’s worst social fears and anxieties, and reinforce a fixed mindset that they are inherently “bad”.

 

Week 4: Set and Setting

  • In addiction, it is not just the substance that matters. Time, place, dose pattern, culture, environment, frame of mind, mood, and expectations can be the difference between addiction and casual use, life and death.

  • Some researchers argue that brains evolved as prediction machines. Pattern-finding in and of itself is rewarding. For example, in music, the interplay between predictable and pleasant patterns releases dopamine when you make an accurate prediction of the pattern, as well as when you experience moments of unexpected but harmonious surprise or variation.

  • Adolescents can make risk decisions that go awry: not because they are emotional and irrational - rather they are too rational. They overestimate the odds of bad outcomes, while also overweighing the immediate benefits and getting lost in deliberation due to inexperience.

  • Mischel’s The Marshmallow Test suggests that addictive behavior occurs when people repeatedly choose pleasure now without worrying about future pain. Learning the benefit of delayed gratification is invaluable in this instance. This can explain why poverty, chaos, and trauma increase addiction risk. There is less rational to delay gratification if the future is ultimately unpredictable or unreliable.

 

Week 5: The Myth of the Addictive Personality

  • As with much early “science,” conclusions were based on correlation rather than causality. However, we know now that addiction is not “caused” by the availability of a specific substance. That would be akin to saying that a symptom is equivalent to the cause. A reminder: it is the habit that strengthens the memory and automates processing. (For example, we wouldn’t say those suffering from OCD catch it by washing their hands repeatedly.)

  • Early science created the idea of the antisocial personality, or “character disorder” -  more recent research cannot confirm this.

  • To the contrary, evidence points to there being no single “addictive personality”.

    • One thing that is a “causative” factor is trauma.

    • 18% of addicts have a personality disorder (4 times more than average, but still a distinct minority)

    • The three known major pathways (all of which involve self-regulation) are: (1) impulsivity, boldness, the need to explore the unknown and take risks (2) depression or anxiety (3) alternating between 1 & 2

    • The above high risk factors have been identified, but don’t fit any single stereotype - all people from all walks of life may show signs of risk, and the above

  • There are three major cultural images of addiction that prove to be stereotypes, rather than reflect the true diversity among those who suffer from addiction: (1) Poor people of color (2) Drug “fiends” (3) “Addictive personality” that is weak, unreliable, selfish, out of control, and unable to resist temptation. Again, these are stereotypes often used in our culture to scapegoat the issue.

Week 6: What IS addiction, after all?

  • It is NOT a “sin”! The issue is primarily biological and psychological, stemming from genetic predispositions, brain development in childhood, and trauma. We have learned that ascribing a moral judgment on those who suffer from addiction is not helpful, and in fact can feed significant portions of the unwanted cycle from which addiction stems. Rather, being valued unconditionally when the expectation is to be shamed or rejected is of utmost importance.

  • The Surgeon General’s Report treats it as a “chronic brain disease.” This is helpful by refocusing us to the biological causes of addiction and away from punishment, but perhaps less helpful in the temptation to consider denying access to (rather than regulation of) drugs as a primary solution.

  • Maia Szalavitz’s research suggests it is more akin to a “learning disorder.” This is helpful by emphasizing the psychological and social/environmental causes of addiction, but perhaps less helpful in the temptation to associate it with the same stigma from which so many learning disorders suffer. Hence why Szalavitz makes an insistence similar to the learning disorder community, that the brain is “unbroken” and does not need to be “cured”, as such. There is still treatment, harm-reduction, and re-learning, but not a denial of the gifts of such predisposed brains. (As we learned, many of the brains that struggle with addiction are also predisposed to doing other things very well - like loving or pursuing ambitions in spite of difficulty.)

  • Both of these primary sources insist that there are multiple paths for treatment and not any one-size-fits-all regimen. They also both agree that widespread access to health care and treatment services is essential.

  • After all this learning, what do you think? The learning doesn’t end here - learning also involves incorporating what we’ve learned into our lives. Take some time to process this information, and then join us as we embark to incorporate this learning in the future. Check out the Hills/Valley Coalition supported by Loeb Family and Friends, the Caron Foundation, High Focus Centers, Bergen County Prevention Coalition, New Pathway Counseling Services and Det. Adam Hampton of the Hillsdale Police Department. This is a group in our area specifically working on issues of youth struggling with addiction.  

  • Give yourself a BIG HUG! If you’ve participated all along, no doubt you’ve done some heavy lifting - both with thinking new thoughts and the emotions that come along with them. This topic affects many of us personally. Take a moment to thank yourself for your courage, and remember that God is proud of and encourages the ways we seek to walk alongside, see Christ in, and continue to learn to love one another unconditionally.

65 Pascack Road, Park Ridge, NJ 07656
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